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General NPI Number Information
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NPI Number | 1467845115
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Entity Type | Organization
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Legal Business Name | AUTISM BEHAVIOR THERAPY
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 5750 DRAKE CT #371
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5750
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Country | US
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Telephone | 703-678-9497
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Fax | 571-312-4642
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Provider Business Mailing Address
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Address Line | 5750 DRAKE CT #371
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5750
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Country | US
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Telephone | 703-678-9497
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Fax | 571-312-4642
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DR. GRACE CHO
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Credential | PH.D.
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Telephone | 703-678-9497
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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 | 0133000299
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License Number State | VA
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