Provider Demographics
NPI:1417747015
Name:PROGRESSIVE AUTISM CONSULTING AND THERAPY
Entity type:Organization
Organization Name:PROGRESSIVE AUTISM CONSULTING AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAKURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABORN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:757-602-1029
Mailing Address - Street 1:1626 LOVITT AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-4451
Mailing Address - Country:US
Mailing Address - Phone:757-602-1029
Mailing Address - Fax:757-602-1029
Practice Address - Street 1:1626 LOVITT AVE APT 11
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4451
Practice Address - Country:US
Practice Address - Phone:757-602-1029
Practice Address - Fax:757-602-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty