Healthcare Provider Details

I. General information

NPI: 1295698835
Provider Name (Legal Business Name): AUTUMN CHANTELL WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9994 SOWDER VILLAGE SQ # 102
MANASSAS VA
20109-5464
US

IV. Provider business mailing address

12022 STARBOARD DR APT 204
RESTON VA
20194-4369
US

V. Phone/Fax

Practice location:
  • Phone: 855-535-3397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: