Healthcare Provider Details

I. General information

NPI: 1437068004
Provider Name (Legal Business Name): BLACKBIRD COLLABORATIVE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 S PINE ST
RICHMOND VA
23220-6237
US

IV. Provider business mailing address

236 S PINE ST
RICHMOND VA
23220-6237
US

V. Phone/Fax

Practice location:
  • Phone: 540-532-0573
  • Fax:
Mailing address:
  • Phone: 540-532-0573
  • 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: MRS. ALEA NICOLE FINNEMORE
Title or Position: LICENSED BEHAVIOR ANALYST
Credential: LBA
Phone: 540-532-0573