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General NPI Number Information
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NPI Number | 1720511801
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Entity Type | Organization
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Legal Business Name | DAYS OF VICTORY CENTER FOR AUTISM INC
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 640 INDEPENDENCE PKWY SUITE 400 B
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5205
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Country | US
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Telephone | 813-951-8026
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Fax |
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Provider Business Mailing Address
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Address Line | 640 INDEPENDENCE PKWY SUITE 400 B
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5205
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Country | US
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Telephone | 813-951-8026
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Fax |
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Authorized Official
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Title or Position | OWNER/CCO
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Name | MRS. LATOYA THOMAS
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Credential | MA,BCBA,LBA
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Telephone | 813-951-8026
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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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