Healthcare Provider Details

I. General information

NPI: 1790440634
Provider Name (Legal Business Name): RVA AUTISM ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 PARK AVE
RICHMOND VA
23226-2031
US

IV. Provider business mailing address

5407 PARK AVE
RICHMOND VA
23226-2031
US

V. Phone/Fax

Practice location:
  • Phone: 757-717-7393
  • Fax:
Mailing address:
  • Phone: 757-717-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE R DAMICO
Title or Position: BCBA/OWNER
Credential: BCBA, LBA
Phone: 757-717-7393