Provider Demographics
NPI:1114617735
Name:SPECTRUM OF CARE AUTISM CENTER
Entity Type:Organization
Organization Name:SPECTRUM OF CARE AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANTONIETT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:706-329-7213
Mailing Address - Street 1:14800 POTOMAC BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4056
Mailing Address - Country:US
Mailing Address - Phone:706-329-7213
Mailing Address - Fax:
Practice Address - Street 1:14800 POTOMAC BRANCH DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4056
Practice Address - Country:US
Practice Address - Phone:706-329-7213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty