MEDICARE: NORTHERN VIRGINIA APPLIED BEHAVIOR ANALYSIS, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1205483260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN VIRGINIA APPLIED BEHAVIOR ANALYSIS, L.L.C.

Provider Business Mailing Address
First Line	:	2528 PAXTON STREET
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192
Country	:	US
Telephone Number	:	703-987-8928
Fax Number	:	703-454-0971

Provider Business Practice Location Address
First Line	:	1984 ISSAC NEWTON SQUARE WEST
Second Line	:	SUITE 204
City	:	RESTON
State	:	VA
Zip	:	20190
Country	:	US
Telephone Number	:	703-987-8928
Fax Number	:	703-454-0971

Authorized Official
Title or Position	:	LICENSED BEHAVIOR ANALYST, LICENSED
Name	:	DR. THEODORE ANDREW HOCH
Credential	:	ED.D., B.C.B.A.-D.,
Telephone Number	:	703-987-8928

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/23/2019

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