Healthcare Provider Details

I. General information

NPI: 1104762574
Provider Name (Legal Business Name): EARLY AUTISM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BREMO RD STE 102
RICHMOND VA
23226-2438
US

IV. Provider business mailing address

2006 BREMO RD STE 102
RICHMOND VA
23226-2438
US

V. Phone/Fax

Practice location:
  • Phone: 804-351-7056
  • Fax:
Mailing address:
  • Phone: 804-351-7056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CIARA CARROLL
Title or Position: REGISTERED BEHAVIORAL TECH
Credential:
Phone: 470-891-6031