| Autism Continuum Therapies Llc | |
|
8500 Executive Park Ave Suite 408 Fairfax VA 22031-2225 | |
| (855) 295-3276 | |
| (818) 241-6853 |
| Full Name | Autism Continuum Therapies Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 8500 Executive Park Ave, Fairfax, Virginia |
| Authorized Official Name and Position | Mark Russell (C.F.O.) |
| Authorized Official Contact | 8182416780 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Autism Continuum Therapies Llc 505 N Brand Blvd #1000 Glendale CA 91203-1906 Ph: (818) 241-6780 | Autism Continuum Therapies Llc 8500 Executive Park Ave Suite 408 Fairfax VA 22031-2225 Ph: (855) 295-3276 |
| NPI Number | 1275934622 |
|---|---|
| Provider Enumeration Date | 09/04/2014 |
| Last Update Date | 09/04/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275934622 | NPI | - | NPPES |
| 1-00-0010 | Other | CA | BCBA-D |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-00-0010 (California) | Secondary |
| 103K00000X | Behavior Analyst | 1-07-3957 (Virginia) | Primary |
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