Healthcare Provider Details

I. General information

NPI: 1679416119
Provider Name (Legal Business Name): EMMA GABRIELLE SELLORS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 KINGS WOOD LN
KING GEORGE VA
22485-5612
US

IV. Provider business mailing address

1701 ASHFORD CIR APT 116
FREDERICKSBURG VA
22401-5072
US

V. Phone/Fax

Practice location:
  • Phone: 540-750-4499
  • Fax:
Mailing address:
  • Phone: 804-296-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: