Healthcare Provider Details

I. General information

NPI: 1942708300
Provider Name (Legal Business Name): MELISSA LOPEZ BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S WASHINGTON ST
ALEXANDRIA VA
22314-3626
US

IV. Provider business mailing address

2423 S ORANGE AVE # 353
ORLANDO FL
32806-4543
US

V. Phone/Fax

Practice location:
  • Phone: 703-870-3880
  • Fax:
Mailing address:
  • Phone: 703-870-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000606
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: