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NPI Code Detail

MEDICARE: ATAP 4 AUTISM INC

MEDICARE: ATAP 4 AUTISM INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2251B00000XCase Management Agency
3251C00000XDevelopmentally Disabled Services Day Training Agency
4261QD1600XDevelopmental Disabilities Clinic/Center
5251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114639688OTHERCOCAQH

General Provider Information

NPI Number : 1881275428
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATAP 4 AUTISM INC
Provider Business Mailing Address
First Line : PO BOX 1325
Second Line :
City : MORRISVILLE
State : NC
Zip : 27560-1325
Country : US
Telephone Number : 252-572-2933
Fax Number : 877-352-0133
Provider Business Practice Location Address
First Line : 120 E BELLE ST
Second Line :
City : HENDERSON
State : NC
Zip : 27536-4502
Country : US
Telephone Number : 252-572-2933
Fax Number : 877-352-0133
Authorized Official
Title or Position : MEMBER
Name : LATEONYA JENKINS
Credential : BS
Telephone Number : 252-572-2933
Provider Enumeration Date : 04/15/2021
Last Update Date : 07/20/2022

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Directions to “ATAP 4 AUTISM INC ” Practice Location

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