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General NPI Number Information
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NPI Number | 1902796915
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Entity Type | Organization
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Legal Business Name | VIRGINIA AUTISM CARE PLLC
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 351 CAMPBELL AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-3637
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Country | US
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Telephone | 845-327-7111
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Fax | 845-875-9420
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Provider Business Mailing Address
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Address Line | 5 PARAGON DR STE 105
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City | MONTVALE
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State | NJ
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Zip | 07645-1739
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Country | US
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Telephone | 845-327-7111
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Fax | 845-875-9420
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TALIA LOPEZ
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Credential |
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Telephone | 845-327-7111
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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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