Provider Demographics
NPI:1649217522
Name:DOMINION CHRISTIAN SCHOOL FOR AUTISM
Entity Type:Organization
Organization Name:DOMINION CHRISTIAN SCHOOL FOR AUTISM
Other - Org Name:THE FOUNDERS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATERMAN
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 1:6818 W GRACE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2831
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:2006-06-01
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000126103K00000X
VA0133000086103K00000X
VA0134000035103K00000X
VA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty