Organization
AUTISM SERVICES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE J GRADY (CHIEF OPERATIONS OFFICER)
(305) 525-8014
Entity
Organization
Contact information
Practice address
10 6TH AVE W, HUNTINGTON, WV 25701-0028
(304) 525-8014
(304) 525-8026
Mailing address
10 6TH AVE W, HUNTINGTON, WV 25701-0028
(304) 525-8014
(304) 525-8026
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
35
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023400001
—
WV
Enumeration date
02/27/2007
Last updated
12/09/2020
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