Provider Demographics
NPI:1588137913
Name:FAMILY SUCCESS ON SPECTRUM LLC
Entity type:Organization
Organization Name:FAMILY SUCCESS ON SPECTRUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MURTADHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-305-6849
Mailing Address - Street 1:8401 PATTERSON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6430
Mailing Address - Country:US
Mailing Address - Phone:804-305-6849
Mailing Address - Fax:
Practice Address - Street 1:8401 PATTERSON AVE STE 205
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6430
Practice Address - Country:US
Practice Address - Phone:804-918-5206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty