Healthcare Provider Details

I. General information

NPI: 1205483260
Provider Name (Legal Business Name): NORTHERN VIRGINIA APPLIED BEHAVIOR ANALYSIS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1984 ISSAC NEWTON SQUARE WEST SUITE 204
RESTON VA
20190
US

IV. Provider business mailing address

2528 PAXTON STREET
WOODBRIDGE VA
22192
US

V. Phone/Fax

Practice location:
  • Phone: 703-987-8928
  • Fax: 703-454-0971
Mailing address:
  • Phone: 703-987-8928
  • Fax: 703-454-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE ANDREW HOCH
Title or Position: LICENSED BEHAVIOR ANALYST, LICENSED
Credential: ED.D., B.C.B.A.-D.,
Phone: 703-987-8928