Healthcare Provider Details

I. General information

NPI: 1831727031
Provider Name (Legal Business Name): 360 BEHAVIOR CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 SWAN RD
WILLIAMSBURG VA
23188-9408
US

IV. Provider business mailing address

5501 SWAN RD
WILLIAMSBURG VA
23188-9408
US

V. Phone/Fax

Practice location:
  • Phone: 757-737-5456
  • Fax: 757-561-2563
Mailing address:
  • Phone: 757-737-5456
  • Fax: 757-561-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. LYNN M HUSBAND
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 757-508-3761