Provider Demographics
NPI:1104584697
Name:ECHOIC AUTISM CENTER INC
Entity type:Organization
Organization Name:ECHOIC AUTISM CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAREE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-883-2733
Mailing Address - Street 1:414 JEFFERSON STREET EXT # C327
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1627
Mailing Address - Country:US
Mailing Address - Phone:470-883-2733
Mailing Address - Fax:
Practice Address - Street 1:414 JEFFERSON STREET EXT # C327
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1627
Practice Address - Country:US
Practice Address - Phone:470-883-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health