Provider Demographics
NPI:1083451280
Name:AUTISM180 LLC
Entity type:Organization
Organization Name:AUTISM180 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REZVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAROUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-441-8715
Mailing Address - Street 1:5960 FAIRVIEW RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0202
Mailing Address - Country:US
Mailing Address - Phone:704-441-8715
Mailing Address - Fax:
Practice Address - Street 1:5960 FAIRVIEW RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0202
Practice Address - Country:US
Practice Address - Phone:704-441-8715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty