Provider Demographics
NPI:1710333513
Name:LUMINA AUTISM CENTER
Entity Type:Organization
Organization Name:LUMINA AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMONA-DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKCIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, MBA
Authorized Official - Phone:404-646-1168
Mailing Address - Street 1:1031 CAMBRIDGE SQ
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1869
Mailing Address - Country:US
Mailing Address - Phone:404-647-1168
Mailing Address - Fax:
Practice Address - Street 1:1031 CAMBRIDGE SQ
Practice Address - Street 2:SUITE F
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1869
Practice Address - Country:US
Practice Address - Phone:404-647-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABCBA# 1-11-8451103K00000X
221700000X, 2251P0200X, 225A00000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12751126OtherCAQH