Organization
AUTISM CONTINUUM THERAPIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK RUSSELL (C.F.O.)
(818) 241-6780
Entity
Organization
Contact information
Practice address
8500 EXECUTIVE PARK AVE, SUITE 408, FAIRFAX, VA 22031-2225
(855) 295-3276
(818) 241-6853
Mailing address
505 N BRAND BLVD, #1000, GLENDALE, CA 91203-1906
(818) 241-6780
(818) 241-6853
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-00-0010
CA
103K00000X
Behavior Analyst
Primary
1-07-3957
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-00-0010
BCBA-D
CA
Enumeration date
09/04/2014
Last updated
09/04/2014
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