Healthcare Provider Details

I. General information

NPI: 1033781984
Provider Name (Legal Business Name): CELESTE MARY ELKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 HILLSMAN ST
FALLS CHURCH VA
22043-3336
US

IV. Provider business mailing address

12223 VISTA BROOKE DR
MANASSAS VA
20112-7532
US

V. Phone/Fax

Practice location:
  • Phone: 703-595-0441
  • Fax:
Mailing address:
  • Phone: 561-699-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000725
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: