Provider Demographics
NPI:1245653989
Name:SOUTHEAST ALABAMA AUTISM CENTER
Entity type:Organization
Organization Name:SOUTHEAST ALABAMA AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-360-1158
Mailing Address - Street 1:1871 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32464-3025
Mailing Address - Country:US
Mailing Address - Phone:334-360-1158
Mailing Address - Fax:334-694-5191
Practice Address - Street 1:210 E GRUBBS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2646
Practice Address - Country:US
Practice Address - Phone:334-360-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-06-2863103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty