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General NPI Number Information
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NPI Number | 1184149403
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Entity Type | Organization
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Legal Business Name | SPECTRUM AUTISM SERVICES, LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 35 WALPOLE ST STE 207
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City | STAFFORD
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State | VA
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Zip | 22554-6546
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Country | US
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Telephone | 540-383-7133
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Fax |
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Provider Business Mailing Address
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Address Line | 12 MONUMENT DR
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City | STAFFORD
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State | VA
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Zip | 22554-8508
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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 | CEO
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Name | NANCY DALY
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Credential | M.A., BCBA, LBA
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Telephone | 540-383-7133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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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