Provider Demographics
NPI:1376390435
Name:UNDER 1 ROOF LLC
Entity type:Organization
Organization Name:UNDER 1 ROOF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-625-6294
Mailing Address - Street 1:4339 RIDGEWOOD CENTER DR # 1071
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5308
Mailing Address - Country:US
Mailing Address - Phone:404-625-6294
Mailing Address - Fax:
Practice Address - Street 1:4301 STRETTON FARM CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5564
Practice Address - Country:US
Practice Address - Phone:404-625-6294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty