Healthcare Provider Details

I. General information

NPI: 1467856435
Provider Name (Legal Business Name): VIRGINIA INSTITUE OF AUTISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 WESTWOOD RD
CHARLOTTESVILLE VA
22903-5149
US

IV. Provider business mailing address

PO BOX 6127
CHARLOTTESVILLE VA
22906-6127
US

V. Phone/Fax

Practice location:
  • Phone: 434-923-8252
  • Fax:
Mailing address:
  • Phone: 434-923-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0133000504
License Number StateVA

VIII. Authorized Official

Name: MELISSA NORDER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 434-923-8252