Provider Demographics
NPI:1083072904
Name:AUTISM SPECIALIST LLC
Entity Type:Organization
Organization Name:AUTISM SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:UTTERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA, LABA
Authorized Official - Phone:571-277-9357
Mailing Address - Street 1:4448 LABRADOR CT
Mailing Address - Street 2:
Mailing Address - City:AMISSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20106-2218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4448 LABRADOR CT
Practice Address - Street 2:
Practice Address - City:AMISSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20106-2218
Practice Address - Country:US
Practice Address - Phone:571-277-9357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0156470103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty