Healthcare Provider Details

I. General information

NPI: 1235810425
Provider Name (Legal Business Name): NOVA BEHAVIORAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E LABURNUM AVENUE STE 3 #141
RICHMOND VA
23222
US

IV. Provider business mailing address

405 E LABURNUM AVENUE SUITE 3 NUMBER 141
RICHMOND VA
23222
US

V. Phone/Fax

Practice location:
  • Phone: 818-518-0306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BOONE
Title or Position: CEO
Credential:
Phone: 818-518-0306