Provider Demographics
NPI:1588028146
Name:THE AUTISM PROGRAM OF VIRGINIA (TAP-VA)
Entity Type:Organization
Organization Name:THE AUTISM PROGRAM OF VIRGINIA (TAP-VA)
Other - Org Name:COMMONWEALTH AUTISM SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-355-0300
Mailing Address - Street 1:4108 E PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2754
Mailing Address - Country:US
Mailing Address - Phone:804-355-0300
Mailing Address - Fax:804-355-0932
Practice Address - Street 1:4108 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2754
Practice Address - Country:US
Practice Address - Phone:804-355-0300
Practice Address - Fax:804-355-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 1041C0700X
VA013300026103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588028146Medicaid
VA3001517948Medicaid