Healthcare Provider Details

I. General information

NPI: 1508167818
Provider Name (Legal Business Name): HEATHER A. SMITH ED.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 GENERAL BOOTH BLVD STE B
VIRGINIA BEACH VA
23454-5910
US

IV. Provider business mailing address

2312 PLANTATION DR
VIRGINIA BEACH VA
23454-2739
US

V. Phone/Fax

Practice location:
  • Phone: 757-301-2411
  • Fax:
Mailing address:
  • Phone: 757-350-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8691
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: