MEDICARE: ANDREA DAWN YOUNKINS BCBA, LBA

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	1-09-6039	VA

General Provider Information

NPI Number	:	1215253174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DAWN YOUNKINS BCBA, LBA

Provider Business Mailing Address
First Line	:	4532 NORMAN RD
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-4925
Country	:	US
Telephone Number	:	757-651-2655
Fax Number	:	757-606-3131

Provider Business Practice Location Address
First Line	:	4532 NORMAN RD
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-4925
Country	:	US
Telephone Number	:	757-651-2655
Fax Number	:	757-606-3131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	08/07/2014

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