Provider Demographics
NPI:1063889327
Name:PINWHEEL AUTISM
Entity type:Organization
Organization Name:PINWHEEL AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:LIPPOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP BCBA LBA
Authorized Official - Phone:757-803-5663
Mailing Address - Street 1:2508 MEDITERRANEAN AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4032
Mailing Address - Country:US
Mailing Address - Phone:757-803-5663
Mailing Address - Fax:757-938-6944
Practice Address - Street 1:2508 MEDITERRANEAN AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4032
Practice Address - Country:US
Practice Address - Phone:757-803-5663
Practice Address - Fax:757-938-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000608103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty