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General NPI Number Information
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NPI Number | 1275426439
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Entity Type | Organization
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Legal Business Name | NEURODIVERSE CONSULTING, LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 196 E HIGH ST
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City | EAST HAMPTON
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State | CT
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Zip | 06424-2007
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Country | US
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Telephone | 860-479-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 349 W MAIN ST
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City | AMSTON
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State | CT
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Zip | 06231-1210
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Country | US
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Telephone | 860-990-3657
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NICHOLE D. COLLINS
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Credential | PHD, BCBA
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Telephone | 860-990-3657
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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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