Healthcare Provider Details

I. General information

NPI: 1164313920
Provider Name (Legal Business Name): AUTISM RISING COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 PAGE AVE STE 440
FAIRFAX VA
22030-4000
US

IV. Provider business mailing address

10640 PAGE AVE STE 440
FAIRFAX VA
22030-4000
US

V. Phone/Fax

Practice location:
  • Phone: 571-663-3008
  • Fax:
Mailing address:
  • Phone: 571-663-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HUSEYN PASHA
Title or Position: OWNER
Credential:
Phone: 571-663-3008