Provider Demographics
NPI:1780099424
Name:AUTISM SPECTRUM COUNSELING CENTER INCORPORATED
Entity type:Organization
Organization Name:AUTISM SPECTRUM COUNSELING CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:ALC
Authorized Official - Phone:334-868-1589
Mailing Address - Street 1:1219 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-5533
Mailing Address - Country:US
Mailing Address - Phone:334-868-1589
Mailing Address - Fax:
Practice Address - Street 1:2358 FAIRLANE DR BLDG G
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1604
Practice Address - Country:US
Practice Address - Phone:334-868-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1774A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty