Provider Demographics
NPI:1972175925
Name:PALMER, AUTUMN NOEL
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NOEL
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 WHITE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FINCASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24090-3340
Mailing Address - Country:US
Mailing Address - Phone:704-207-3472
Mailing Address - Fax:
Practice Address - Street 1:967 WHITE CHURCH RD
Practice Address - Street 2:
Practice Address - City:FINCASTLE
Practice Address - State:VA
Practice Address - Zip Code:24090-3340
Practice Address - Country:US
Practice Address - Phone:704-207-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-168210106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician