Tidewater Autism Consultation and Therapy, LLC

NPI #1639767981 in Gloucester, Virginia

Provider Information

NPI Number: 1639767981
Entity Type: Organization
Organization Name: Tidewater Autism Consultation and Therapy, LLC
Primary Specialty: Behavior Analyst
Enumeration Date: Jan 4, 2021
Last Updated: Jan 4, 2021

Practice Location

Address: 6676 MAGNOLIA DR
City: Gloucester
State: Virginia
ZIP Code: 23061-4239
Phone: (757) 604-3394

Authorized Official

Name: JOSEPH D LEGG, MA, BCBA, LBA
Title: BEHAVIOR ANALYSY
Phone: (757) 604-3394

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Analyst	103K00000X	Primary

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