Basic Information
| Provider Information | |||||||||
| NPI: | 1366799611 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABC'S OF APPLIED BEHAVIOR ANALYSIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 KINGS CREST DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241535114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405889582 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 KINGS CREST DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241535114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405889582 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2012 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | HOPRICH | ||||||||
| AuthorizedOfficialFirstName: | LISSA | ||||||||
| AuthorizedOfficialMiddleName: | DAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIOR ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 5405889582 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MA, BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 1119221 | VA | Y | Agencies | Community/Behavioral Health |
No ID Information.