Healthcare Provider Details

I. General information

NPI: 1750896999
Provider Name (Legal Business Name): ALEXANDRA PAIGE KELLAS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA PAIGE JONES BCBA

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12610 PATRICK HENRY DR STE M
NEWPORT NEWS VA
23602-9538
US

IV. Provider business mailing address

118 RAILWAY RD
YORKTOWN VA
23692-2930
US

V. Phone/Fax

Practice location:
  • Phone: 757-304-0224
  • Fax:
Mailing address:
  • Phone: 757-817-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-40962
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-44279
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: