Healthcare Provider Details

I. General information

NPI: 1730697673
Provider Name (Legal Business Name): ALENA ISAEVA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 PORTSMOUTH BLVD STE B
CHESAPEAKE VA
23321-2154
US

IV. Provider business mailing address

3101 MAGIC HOLLOW BLVD
VIRGINIA BEACH VA
23453-3010
US

V. Phone/Fax

Practice location:
  • Phone: 757-292-4774
  • Fax:
Mailing address:
  • Phone: 757-639-2218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000271
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002097
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: