| Tidewater Autism Consultation And Therapy, Llc | |
|
6676 Magnolia Dr Gloucester VA 23061-4239 | |
| (757) 604-3394 | |
| Not Available |
| Full Name | Tidewater Autism Consultation And Therapy, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 6676 Magnolia Dr, Gloucester, Virginia |
| Authorized Official Name and Position | Joseph D Legg (BEHAVIOR ANALYSY) |
| Authorized Official Contact | 7576043394 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Autism Consultation And Therapy, Llc 6676 Magnolia Dr Gloucester VA 23061-4239 Ph: (757) 604-3394 | Tidewater Autism Consultation And Therapy, Llc 6676 Magnolia Dr Gloucester VA 23061-4239 Ph: (757) 604-3394 |
| NPI Number | 1639767981 |
|---|---|
| Provider Enumeration Date | 01/04/2021 |
| Last Update Date | 01/04/2021 |
| Certification Date | 01/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639767981 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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