Healthcare Provider Details

I. General information

NPI: 1750051223
Provider Name (Legal Business Name): IMPROVED DYNAMICS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 BORO PL FL 4
MC LEAN VA
22102-3627
US

IV. Provider business mailing address

1640 BORO PL FL 4
MC LEAN VA
22102-3627
US

V. Phone/Fax

Practice location:
  • Phone: 571-992-1600
  • Fax:
Mailing address:
  • Phone: 571-464-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE ELIZABETH BANISH
Title or Position: OWNER
Credential: BCBA LBA
Phone: 571-464-4299