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General NPI Number Information
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NPI Number | 1053671735
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Entity Type | Organization
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Legal Business Name | OBX AUTISM BEHAVIOR THERAPY INC
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 900 TREVOR CT
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City | CHESAPEAKE
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State | VA
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Zip | 23322-8917
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Country | US
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Telephone | 252-232-8892
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Fax | 252-558-0496
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Provider Business Mailing Address
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Address Line | 900 TREVOR CT
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City | CHESAPEAKE
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State | VA
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Zip | 23322-8917
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Country | US
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Telephone | 407-276-1042
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Fax | 252-558-0496
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LORENA O DECKER
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Credential | BCBA
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Telephone | 407-276-1042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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