Provider Demographics
NPI:1316343254
Name:AUTISM SPECTRUM INTERVENTION SERVICES AND TRAINING (ASIST)
Entity type:Organization
Organization Name:AUTISM SPECTRUM INTERVENTION SERVICES AND TRAINING (ASIST)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LONI
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD AND BCBA
Authorized Official - Phone:909-366-9344
Mailing Address - Street 1:1638 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-3364
Mailing Address - Country:US
Mailing Address - Phone:909-366-9344
Mailing Address - Fax:909-235-4762
Practice Address - Street 1:1638 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-3364
Practice Address - Country:US
Practice Address - Phone:909-366-9344
Practice Address - Fax:909-235-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency