Provider Demographics
NPI:1356664437
Name:CHARLESTON AUTISM ACADEMY
Entity Type:Organization
Organization Name:CHARLESTON AUTISM ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF TRUSTEES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MISENHELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-881-0330
Mailing Address - Street 1:480 JESSEN LN
Mailing Address - Street 2:STE D
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
Practice Address - Street 2:STE D
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:2010-03-03
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
SC3529225XP0200X
SC4491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty