Provider Demographics
NPI:1780961706
Name:CHARLESTON AUTISM ACADEMY
Entity type:Organization
Organization Name:CHARLESTON AUTISM ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISENHELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-881-0330
Mailing Address - Street 1:480 JESSEN LN STE D
Mailing Address - Street 2:
Mailing Address - City:WANDO
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7915
Mailing Address - Country:US
Mailing Address - Phone:843-881-0330
Mailing Address - Fax:843-405-7020
Practice Address - Street 1:480 JESSEN LN STE D
Practice Address - Street 2:
Practice Address - City:WANDO
Practice Address - State:SC
Practice Address - Zip Code:29492-7915
Practice Address - Country:US
Practice Address - Phone:843-881-0330
Practice Address - Fax:843-405-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3529225X00000X
SC4491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty