Provider Demographics
NPI:1790509560
Name:WAVES AUTISM CENTER, LLC
Entity type:Organization
Organization Name:WAVES AUTISM CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:COUNSELOR, MA
Authorized Official - Phone:478-733-2597
Mailing Address - Street 1:103 LENOX DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3603
Mailing Address - Country:US
Mailing Address - Phone:478-733-2597
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE POINTE # A8
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3437
Practice Address - Country:US
Practice Address - Phone:478-733-2597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health