Provider Demographics
NPI:1679225593
Name:AUTISM LIVING EXPERIENCE OF NORTH CAROLINA
Entity Type:Organization
Organization Name:AUTISM LIVING EXPERIENCE OF NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:C
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-838-9065
Mailing Address - Street 1:6700 ALEXANDER BELL DR STE 253
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2122
Mailing Address - Country:US
Mailing Address - Phone:443-838-9065
Mailing Address - Fax:443-276-6720
Practice Address - Street 1:875 RAYS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-5910
Practice Address - Country:US
Practice Address - Phone:253-278-7439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty