Provider Demographics
NPI:1073101267
Name:ADAPTIVE TEACHING AND LEARNING AUTISM SERVICES
Entity Type:Organization
Organization Name:ADAPTIVE TEACHING AND LEARNING AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA/LBA
Authorized Official - Phone:301-703-9923
Mailing Address - Street 1:10726 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-2630
Mailing Address - Country:US
Mailing Address - Phone:301-703-9923
Mailing Address - Fax:
Practice Address - Street 1:10726 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-2630
Practice Address - Country:US
Practice Address - Phone:301-703-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty