Provider Demographics
NPI:1053671735
Name:OBX AUTISM BEHAVIOR THERAPY INC
Entity Type:Organization
Organization Name:OBX AUTISM BEHAVIOR THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:O
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-276-1042
Mailing Address - Street 1:900 TREVOR CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8917
Mailing Address - Country:US
Mailing Address - Phone:407-276-1042
Mailing Address - Fax:252-558-0496
Practice Address - Street 1:900 TREVOR CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8917
Practice Address - Country:US
Practice Address - Phone:252-232-8892
Practice Address - Fax:252-558-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA0114370103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty