Organization
GENESIS AUTISM CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAMERON SEVERO ASHWORTH (OWNER)
(757) 927-1527
Entity
Organization
Contact information
Practice address
2206 EXECUTIVE DR STE A, HAMPTON, VA 23666-2583
(929) 436-3747
(757) 838-2573
Mailing address
2202 EXECUTIVE DR STE C, HAMPTON, VA 23666-6604
(757) 827-7707
(757) 838-2573
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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