Provider Demographics
NPI:1558881656
Name:CHIPOLA AREA AUTISM RESOURCE CENTER, INC.
Entity Type:Organization
Organization Name:CHIPOLA AREA AUTISM RESOURCE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:850-272-6099
Mailing Address - Street 1:4438 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-3125
Mailing Address - Country:US
Mailing Address - Phone:850-272-6099
Mailing Address - Fax:
Practice Address - Street 1:5865 NEALS LANDING RD
Practice Address - Street 2:
Practice Address - City:BASCOM
Practice Address - State:FL
Practice Address - Zip Code:32423-9213
Practice Address - Country:US
Practice Address - Phone:850-272-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-23058103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty