Healthcare Provider Details

I. General information

NPI: 1184149403
Provider Name (Legal Business Name): SPECTRUM AUTISM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WALPOLE ST STE 207
STAFFORD VA
22554-6546
US

IV. Provider business mailing address

12 MONUMENT DR
STAFFORD VA
22554-8508
US

V. Phone/Fax

Practice location:
  • Phone: 540-383-7133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NANCY DALY
Title or Position: CEO
Credential: M.A., BCBA, LBA
Phone: 540-383-7133