Healthcare Provider Details

I. General information

NPI: 1053731448
Provider Name (Legal Business Name): PETRA STOCKHAUS WHITE M.ED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15713 MOSS FIRE CT
MOSELEY VA
23120-1614
US

IV. Provider business mailing address

2704 MEETING GATE CT
MIDLOTHIAN VA
23112-4322
US

V. Phone/Fax

Practice location:
  • Phone: 804-601-0132
  • Fax: 804-816-4550
Mailing address:
  • Phone: 804-536-9359
  • Fax: 804-816-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1053731448
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: