Healthcare Provider Details

I. General information

NPI: 1801400304
Provider Name (Legal Business Name): HARLEIGH DELAYNI WARREN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 PETERS CREEK RD NW STE C
ROANOKE VA
24019-2757
US

IV. Provider business mailing address

1111 SPRING CREEK DR APT 207
FOREST VA
24551-8210
US

V. Phone/Fax

Practice location:
  • Phone: 804-549-2376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: