Provider Demographics
NPI:1124323506
Name:COLUMBIA ADVANCED SCIENCE, LC
Entity type:Organization
Organization Name:COLUMBIA ADVANCED SCIENCE, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:XIAOLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:410-979-7999
Mailing Address - Street 1:9804 MADELAINE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4918
Mailing Address - Country:US
Mailing Address - Phone:410-979-7999
Mailing Address - Fax:410-480-8281
Practice Address - Street 1:9804 MADELAINE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4918
Practice Address - Country:US
Practice Address - Phone:410-979-7999
Practice Address - Fax:410-480-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-05-2471103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty