Provider Demographics
NPI:1730839887
Name:AUTISM THERAPY, LLC
Entity type:Organization
Organization Name:AUTISM THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:MATEEN
Authorized Official - Last Name:YOUSUFZAI
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:703-286-9878
Mailing Address - Street 1:14608 THERA WAY
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3451
Mailing Address - Country:US
Mailing Address - Phone:703-286-9878
Mailing Address - Fax:
Practice Address - Street 1:14608 THERA WAY
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-3451
Practice Address - Country:US
Practice Address - Phone:703-286-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health