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General NPI Number Information
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NPI Number | 1720349087
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Entity Type | Organization
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Legal Business Name | AUTISM SPECTRUM THERAPY LLC
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 6401 CRESCENT WAY APT 301
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City | NORFOLK
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State | VA
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Zip | 23513-1454
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Country | US
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Telephone | 757-469-3773
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Fax | 757-257-9523
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Provider Business Mailing Address
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Address Line | 6401 CRESCENT WAY APT 301
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City | NORFOLK
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State | VA
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Zip | 23513-1454
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Country | US
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Telephone | 757-469-3773
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Fax | 757-257-9523
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Authorized Official
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Title or Position | PRESIDENT/ BCBA
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Name | MRS. AMBER ZOOBERG
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Credential | M. S. ED., BCBA
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Telephone | 757-469-3773
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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 | 1-10-7863
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License Number State | VA
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