Healthcare Provider Details

I. General information

NPI: 1558865360
Provider Name (Legal Business Name): CHOICE POINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 FRAYS RIDGE XING
EARLYSVILLE VA
22936-1878
US

IV. Provider business mailing address

1893 FRAYS RIDGE XING
EARLYSVILLE VA
22936-1878
US

V. Phone/Fax

Practice location:
  • Phone: 434-962-8119
  • Fax: 434-923-8615
Mailing address:
  • Phone: 434-962-8119
  • Fax: 434-923-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000840
License Number StateVA

VIII. Authorized Official

Name: DR. LISA TULLO
Title or Position: BEHAVIOR ANALYST
Credential: PH.D., BCBA-D
Phone: 434-962-8119