Healthcare Provider Details

I. General information

NPI: 1386158012
Provider Name (Legal Business Name): MELISSA PFLAEGING ABA THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3300 GRAYLAND AVE
RICHMOND VA
23221-3407
US

IV. Provider business mailing address

3300 GRAYLAND AVE
RICHMOND VA
23221-3407
US

V. Phone/Fax

Practice location:
  • Phone: 646-209-2139
  • Fax: 804-359-2363
Mailing address:
  • Phone: 646-209-2139
  • Fax: 804-359-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000723
License Number StateVA

VIII. Authorized Official

Name: MELISSA PFLAEGING
Title or Position: BEHAVIOR ANALYST
Credential: LBA, BCBA
Phone: 646-209-2139