Provider Demographics
NPI:1457123515
Name:SPECTRUM SUPPORT SERVICES, L.L.C.
Entity Type:Organization
Organization Name:SPECTRUM SUPPORT SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, LBA
Authorized Official - Phone:804-836-6156
Mailing Address - Street 1:2308 SHOREHAM DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2642
Mailing Address - Country:US
Mailing Address - Phone:804-836-6156
Mailing Address - Fax:
Practice Address - Street 1:2308 SHOREHAM DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-2642
Practice Address - Country:US
Practice Address - Phone:804-836-6156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health