Provider Demographics
NPI:1871204396
Name:AUTISM CONNECTION INC.
Entity type:Organization
Organization Name:AUTISM CONNECTION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUKOULIS
Authorized Official - Suffix:
Authorized Official - Credentials:MAT
Authorized Official - Phone:273-660-3237
Mailing Address - Street 1:3359 CHEVERLY CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2854
Mailing Address - Country:US
Mailing Address - Phone:727-366-0323
Mailing Address - Fax:
Practice Address - Street 1:101 E WHEEL RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6114
Practice Address - Country:US
Practice Address - Phone:727-366-0323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD547900201Medicaid