Provider Demographics
NPI:1023265097
Name:AUTISM SUPPORT AND PROGRAMS
Entity type:Organization
Organization Name:AUTISM SUPPORT AND PROGRAMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-270-5499
Mailing Address - Street 1:200 ISLAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28457-9409
Mailing Address - Country:US
Mailing Address - Phone:910-270-5499
Mailing Address - Fax:910-270-9417
Practice Address - Street 1:200 ISLAND CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NC
Practice Address - Zip Code:28457-9409
Practice Address - Country:US
Practice Address - Phone:910-270-5499
Practice Address - Fax:910-270-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health