Provider Demographics
NPI:1265255319
Name:GENEVA CENTER FOR AUTISM LLC
Entity type:Organization
Organization Name:GENEVA CENTER FOR AUTISM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LISENBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-408-4396
Mailing Address - Street 1:8001 N POINT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3247
Mailing Address - Country:US
Mailing Address - Phone:336-408-4396
Mailing Address - Fax:
Practice Address - Street 1:8001 N POINT BLVD STE B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3247
Practice Address - Country:US
Practice Address - Phone:336-408-4396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty