Healthcare Provider Details

I. General information

NPI: 1962160267
Provider Name (Legal Business Name): BIANCA CRAIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 NEWTOWN RD STE 100
NORFOLK VA
23502-4803
US

IV. Provider business mailing address

131 ELDEN ST STE 302
HERNDON VA
20170-4851
US

V. Phone/Fax

Practice location:
  • Phone: 757-243-1033
  • Fax:
Mailing address:
  • Phone: 844-822-2250
  • Fax: 703-435-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-351460
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: