Healthcare Provider Details

I. General information

NPI: 1255248514
Provider Name (Legal Business Name): DIGNA SUSEL DUBON RAPALO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 4TH ST
SALEM VA
24153-5029
US

IV. Provider business mailing address

500 E 4TH ST
SALEM VA
24153-5029
US

V. Phone/Fax

Practice location:
  • Phone: 888-515-1793
  • Fax:
Mailing address:
  • Phone: 888-515-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2837757
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: