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General NPI Number Information
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NPI Number | 1760743025
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Entity Type | Organization
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Legal Business Name | THE MAY CENTER FOR AUTISM SPECTRUM DISORDERS
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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 | 102 ELIZABETH ST STE C
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5679
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Country | US
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Telephone | 910-333-0814
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Fax | 910-333-0817
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Provider Business Mailing Address
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Address Line | 14 PACELLA PARK DR
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City | RANDOLPH
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State | MA
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Zip | 02368-1756
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Country | US
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Telephone | 781-437-1200
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Fax | 781-551-9880
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ANNE KATHRYN STULL
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Credential | M.A LPA BCBA
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Telephone | 910-333-0814
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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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