Provider Demographics
NPI:1407053549
Name:AUTISM OUTREACH, INC.
Entity Type:Organization
Organization Name:AUTISM OUTREACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA PROGRAM CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-689-0019
Mailing Address - Street 1:701 EMERALD HILL DR NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3633
Mailing Address - Country:US
Mailing Address - Phone:571-236-1110
Mailing Address - Fax:
Practice Address - Street 1:11337 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5205
Practice Address - Country:US
Practice Address - Phone:703-689-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization