Healthcare Provider Details

I. General information

NPI: 1992116677
Provider Name (Legal Business Name): THE AUTISM PROGRAM OF VIRGINIA (TAP-VA)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 01/26/2023
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 E PARHAM RD
RICHMOND VA
23228-2754
US

IV. Provider business mailing address

4108 E PARHAM RD
RICHMOND VA
23228-2754
US

V. Phone/Fax

Practice location:
  • Phone: 804-355-0300
  • Fax: 804-355-0932
Mailing address:
  • Phone: 804-355-0300
  • Fax: 804-355-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number001811
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY M BOWEN
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 804-355-0300