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General NPI Number Information
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NPI Number | 1437924123
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Entity Type | Organization
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Legal Business Name | LIFE CONNECTIONS AUTISM SERVICES
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 408 N CEDAR BLUFF RD STE 252
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City | KNOXVILLE
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State | TN
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Zip | 37923-3641
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Country | US
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Telephone | 865-323-3870
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Fax | 865-888-5819
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Provider Business Mailing Address
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Address Line | 408 N CEDAR BLUFF RD STE 252
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City | KNOXVILLE
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State | TN
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Zip | 37923-3641
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Country | US
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Telephone | 865-323-3870
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Fax | 865-888-5819
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Authorized Official
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Title or Position | OWNER/CEO
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Name | SARAH DEFALCO GIBBS
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Credential | LPC-MHSP
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Telephone | 865-323-3870
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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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