Provider Demographics
NPI:1598458614
Name:SOAR AUTISM CENTER
Entity Type:Organization
Organization Name:SOAR AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:404-308-9375
Mailing Address - Street 1:2199 SAGE MOUNTAIN CT SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2207
Mailing Address - Country:US
Mailing Address - Phone:404-308-9375
Mailing Address - Fax:404-595-5251
Practice Address - Street 1:2199 SAGE MOUNTAIN CT SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2207
Practice Address - Country:US
Practice Address - Phone:404-308-9375
Practice Address - Fax:404-595-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty