Provider Demographics
NPI:1114745171
Name:RAE, AUTUMN FAITH
Entity type:Individual
Prefix:MISS
First Name:AUTUMN
Middle Name:FAITH
Last Name:RAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 SHELL RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-3236
Mailing Address - Country:US
Mailing Address - Phone:757-803-7727
Mailing Address - Fax:
Practice Address - Street 1:729 SHELL RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-3236
Practice Address - Country:US
Practice Address - Phone:757-803-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst