Healthcare Provider Details

I. General information

NPI: 1568730349
Provider Name (Legal Business Name): KORA ANALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9034 FOX GRAPE LN
SPRINGFIELD VA
22152-2503
US

IV. Provider business mailing address

6420 OLDE BULLOCKS CIRCLE
SUFFOLK VA
23435
US

V. Phone/Fax

Practice location:
  • Phone: 703-675-7465
  • Fax: 888-548-0846
Mailing address:
  • Phone: 703-675-7465
  • Fax: 888-548-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN FRIGELJ
Title or Position: OWNER
Credential: BCBA
Phone: 703-675-7465