Healthcare Provider Details

I. General information

NPI: 1821902289
Provider Name (Legal Business Name): EVERGREEN ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8704 ROUTE 29 STE 300
FAIRFAX VA
22031-2104
US

IV. Provider business mailing address

8704 ROUTE 29 STE 300
FAIRFAX VA
22031-2104
US

V. Phone/Fax

Practice location:
  • Phone: 703-534-5049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JIN M CHOI
Title or Position: OWNER
Credential:
Phone: 571-335-3636