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General NPI Number Information
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NPI Number | 1790585586
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Entity Type | Organization
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Legal Business Name | AUTISM INCLUSION CARE LLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 10304 EATON PL STE 100
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City | FAIRFAX
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State | VA
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Zip | 22030-2221
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Country | US
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Telephone | 804-742-2033
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Fax |
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Provider Business Mailing Address
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Address Line | 10304 EATON PL STE 100
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City | FAIRFAX
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State | VA
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Zip | 22030-2221
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Country | US
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Telephone | 804-742-2033
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ABDUL QAYYUM SAMER
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Credential | MBR
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Telephone | 571-888-1842
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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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