Provider Demographics
NPI:1598189763
Name:AUTISM INNOVATIONS, LLC
Entity Type:Organization
Organization Name:AUTISM INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, NBCT
Authorized Official - Phone:919-390-7771
Mailing Address - Street 1:93 E TRAFALGAR CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-3755
Mailing Address - Country:US
Mailing Address - Phone:919-390-7771
Mailing Address - Fax:919-390-7781
Practice Address - Street 1:93 E TRAFALGAR CT
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-3755
Practice Address - Country:US
Practice Address - Phone:919-390-7771
Practice Address - Fax:919-390-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023448883Medicaid