Healthcare Provider Details

I. General information

NPI: 1942117239
Provider Name (Legal Business Name): ALLIANCE BEHAVIOR THERAPY AND CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4412 SUNRAY AVE
CHESAPEAKE VA
23321-2628
US

IV. Provider business mailing address

4412 SUNRAY AVE
CHESAPEAKE VA
23321-2628
US

V. Phone/Fax

Practice location:
  • Phone: 757-774-3000
  • Fax:
Mailing address:
  • Phone: 757-774-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA M GODWIN
Title or Position: BCBA, OWNER
Credential: BCBA
Phone: 757-774-3000