Healthcare Provider Details

I. General information

NPI: 1932486750
Provider Name (Legal Business Name): RACHEL CONNER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 RAINTREE RD SUITE 220B
CHESAPEAKE VA
23321-3700
US

IV. Provider business mailing address

4016 RAINTREE RD SUITE 220B
CHESAPEAKE VA
23321-3700
US

V. Phone/Fax

Practice location:
  • Phone: 757-465-3933
  • Fax: 757-465-3944
Mailing address:
  • Phone: 757-465-3933
  • Fax: 757-465-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9500
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: