Basic Information
| Provider Information | |||||||||
| NPI: | 1417455643 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILLEARY | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | SEAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PBSF, BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10304 SPOTSYLVANIA AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224088605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407106085 | ||||||||
| FaxNumber: | 5407106447 | ||||||||
| Practice Location | |||||||||
| Address1: | 3363 SHAWNEE DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226026301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405350043 | ||||||||
| FaxNumber: | 5405350011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 01/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0133000887 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.