| The Pediatric Autism Center, Llc | |
|
4304 Eagle Trace Ct Waldorf MD 20602-3116 | |
| (478) 273-9199 | |
| Not Available |
| Full Name | The Pediatric Autism Center, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 4304 Eagle Trace Ct, Waldorf, Maryland |
| Authorized Official Name and Position | Chante Nicole Dix (CEO) |
| Authorized Official Contact | 4782739199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Pediatric Autism Center, Llc 4304 Eagle Trace Ct Waldorf MD 20602-3116 Ph: () - | The Pediatric Autism Center, Llc 4304 Eagle Trace Ct Waldorf MD 20602-3116 Ph: (478) 273-9199 |
| NPI Number | 1477120889 |
|---|---|
| Provider Enumeration Date | 06/06/2021 |
| Last Update Date | 06/06/2021 |
| Certification Date | 06/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477120889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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