Healthcare Provider Details

I. General information

NPI: 1659180826
Provider Name (Legal Business Name): BLUE GEMS ABA THERAPY VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 WILLOW OAKS CORPORATE DR STE 600
FAIRFAX VA
22031-4516
US

IV. Provider business mailing address

8280 WILLOW OAKS CORPORATE DR STE 600
FAIRFAX VA
22031-4516
US

V. Phone/Fax

Practice location:
  • Phone: 571-370-4734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WOLF
Title or Position: CEO
Credential:
Phone: 617-297-7998