Healthcare Provider Details

I. General information

NPI: 1861069106
Provider Name (Legal Business Name): GINA THOMPSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 WATERFORD LAKE DR STE 102
MIDLOTHIAN VA
23112-3994
US

IV. Provider business mailing address

3433 BRAMBLETON AVE STE 201A
ROANOKE VA
24018-6527
US

V. Phone/Fax

Practice location:
  • Phone: 804-895-4678
  • Fax:
Mailing address:
  • Phone: 540-291-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003444
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: