Healthcare Provider Details

I. General information

NPI: 1154814515
Provider Name (Legal Business Name): MR. GIOVANTE DERICK SKINNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GIOVANTE DERICK BROWN

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 CENTERVIEW DR STE 400B
CHANTILLY VA
20151-3285
US

IV. Provider business mailing address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 571-554-5730
  • Fax:
Mailing address:
  • Phone: 844-244-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2832717
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-231311
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: