Provider Demographics
NPI:1477176162
Name:MOUNTAINEER'S SCHOOL OF AUTISM, INC
Entity Type:Organization
Organization Name:MOUNTAINEER'S SCHOOL OF AUTISM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-366-5772
Mailing Address - Street 1:1340 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7408
Mailing Address - Country:US
Mailing Address - Phone:561-932-3938
Mailing Address - Fax:
Practice Address - Street 1:1340 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7408
Practice Address - Country:US
Practice Address - Phone:561-932-3938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty