Basic Information
| Provider Information | |||||||||
| NPI: | 1659993525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOMES | ||||||||
| FirstName: | BRITTANI | ||||||||
| MiddleName: | JACINTA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.ED., BCBA, LBA. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5680 OLYMPIA FIELDS PL | ||||||||
| Address2: | |||||||||
| City: | HAYMARKET | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201693154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5719918028 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 50101 GOVERNORS DR STE 170 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275179257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195894523 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2020 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0133001529 | VA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.