Provider Demographics
NPI:1144951351
Name:INTEGRATED AUTISM BEHAVIOR SERVICES LLC
Entity type:Organization
Organization Name:INTEGRATED AUTISM BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAZLUL KHALEQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:202-340-6334
Mailing Address - Street 1:1110 HERNDON PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5547
Mailing Address - Country:US
Mailing Address - Phone:703-943-6560
Mailing Address - Fax:571-526-5550
Practice Address - Street 1:1110 HERNDON PKWY STE 305
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5547
Practice Address - Country:US
Practice Address - Phone:703-943-6560
Practice Address - Fax:571-685-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-19
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities