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General NPI Number Information
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NPI Number | 1346609989
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Entity Type | Organization
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Legal Business Name | AUTISM SPECIALIST
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 4818 ERTTER DR
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City | ROCKVILLE
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State | MD
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Zip | 20852-2202
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Country | US
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Telephone | 321-704-9020
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Fax |
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Provider Business Mailing Address
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Address Line | 4818 ERTTER DR
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City | ROCKVILLE
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State | MD
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Zip | 20852-2202
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Country | US
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Telephone | 321-704-9020
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | ANGELA VANCE
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Credential |
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Telephone | 321-704-9020
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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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