Healthcare Provider Details

I. General information

NPI: 1235637513
Provider Name (Legal Business Name): SIERRA M COLLINS BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9902 MAGNOLIA POINTE CT
GLEN ALLEN VA
23059-6534
US

IV. Provider business mailing address

104 N ARTHUR ASHE BLVD
RICHMOND VA
23220-4333
US

V. Phone/Fax

Practice location:
  • Phone: 336-428-1729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000277
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-44240
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: