The Pediatric Autism Center, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

THE PEDIATRIC AUTISM CENTER, LLC

Practice address

4304 Eagle Trace CT
Waldorf, MD 20602-3116

Phone

(478) 273-9199

NPI assigned

Jun 6, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chante Nicole Dix, MA, BCBANPI 1619442712

Title

Ceo

Phone

(478) 273-9199

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chante Nicole Dix, BCBA

  • Behavior Analyst
  • Warner Robins, GA
  • NPI 1619442712
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622937600000",
    "number": "1477120889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4304 EAGLE TRACE CT",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4304 EAGLE TRACE CT",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023116",
            "telephone_number": "478-273-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC AUTISM CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-06",
        "last_updated": "2021-06-06",
        "certification_date": "2021-06-06",
        "status": "A",
        "authorized_official_last_name": "DIX",
        "authorized_official_first_name": "CHANTE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-273-9199",
        "authorized_official_credential": "MA, BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Waldorf, MD
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.