Healthcare Provider Details

I. General information

NPI: 1225475130
Provider Name (Legal Business Name): BEHAVIORAL INTELLIGENCE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 FOREST POINT CIR SUITE 160
MANASSAS VA
20110-4765
US

IV. Provider business mailing address

12059 BRIDLE POST PL
MANASSAS VA
20112-5515
US

V. Phone/Fax

Practice location:
  • Phone: 540-846-5429
  • Fax:
Mailing address:
  • Phone: 540-846-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001517
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number07170000
License Number StateVA

VIII. Authorized Official

Name: DR. STEPHEN ROBERT BAND
Title or Position: OWNER AND SOLE MEMBER
Credential: PH.D.
Phone: 540-846-5429