Provider Demographics
NPI:1932808235
Name:ARK AUTISM BEHAVIOR THERAPY
Entity Type:Organization
Organization Name:ARK AUTISM BEHAVIOR THERAPY
Other - Org Name:ARK AUTSIM BEHAVIOR THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RBT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAKIL
Authorized Official - Middle Name:
Authorized Official - Last Name:QARAR
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:571-343-9182
Mailing Address - Street 1:13137 THRIFT LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-6102
Mailing Address - Country:US
Mailing Address - Phone:571-343-9182
Mailing Address - Fax:
Practice Address - Street 1:13137 THRIFT LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-6102
Practice Address - Country:US
Practice Address - Phone:571-343-9182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty