Healthcare Provider Details

I. General information

NPI: 1548054240
Provider Name (Legal Business Name): AUTISM WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18605 KERILL RD
TRIANGLE VA
22172-2064
US

IV. Provider business mailing address

18605 KERILL RD
TRIANGLE VA
22172-2064
US

V. Phone/Fax

Practice location:
  • Phone: 425-350-6611
  • Fax:
Mailing address:
  • Phone: 425-350-6611
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. BAHIJAH D. SHEIBANEE
Title or Position: CLINICAL DIRECTOR/BCBA
Credential: M.A., BCBA, LBA
Phone: 954-305-7252