Healthcare Provider Details
I. General information
NPI: 1609705045
Provider Name (Legal Business Name): ABLE STARS ABA VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
10505 JUDICIAL DR STE 300
FAIRFAX VA
22030-5157
US
IV. Provider business mailing address
10505 JUDICIAL DR STE 300
FAIRFAX VA
22030-5157
US
V. Phone/Fax
- Phone: 410-525-5005
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
SAMUEL
KALLNER
Title or Position: CEO/FOUNDER
Credential:
Phone: 410-525-5005