Provider Demographics
NPI:1104596642
Name:AUTISM CENTERS OF NORTH CAROLINA
Entity type:Organization
Organization Name:AUTISM CENTERS OF NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:CONN
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA, CCEP
Authorized Official - Phone:984-789-2433
Mailing Address - Street 1:10370 MONCREIFFE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7823
Mailing Address - Country:US
Mailing Address - Phone:704-609-4456
Mailing Address - Fax:
Practice Address - Street 1:10370 MONCREIFFE RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7823
Practice Address - Country:US
Practice Address - Phone:984-789-2433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty