Healthcare Provider Details

I. General information

NPI: 1932066396
Provider Name (Legal Business Name): LINA LAMANTIA M.ADS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25858 RAWLEY SPRINGS DR
CHANTILLY VA
20152-5767
US

IV. Provider business mailing address

25858 RAWLEY SPRINGS DR
CHANTILLY VA
20152-5767
US

V. Phone/Fax

Practice location:
  • Phone: 727-504-2284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004783
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: