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General NPI Number Information
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NPI Number | 1033785340
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Entity Type | Organization
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Legal Business Name | ADVANCED AUTISM SERVICES VA LLC
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 780 LYNNHAVEN PKWY STE 400
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7332
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Country | US
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Telephone | 602-584-9860
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Fax | 602-715-1135
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Provider Business Mailing Address
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Address Line | 36 AIRPORT RD STE 105
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City | LAKEWOOD
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State | NJ
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Zip | 08701-7034
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MALKA HERSKO
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Credential | MS CCC SLP
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Telephone | 602-584-9860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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