Healthcare Provider Details

I. General information

NPI: 1417455643
Provider Name (Legal Business Name): CHRISTOPHER SEAN HILLEARY PBSF, BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 SHAWNEE DR STE 1
WINCHESTER VA
22602-6301
US

IV. Provider business mailing address

10304 SPOTSYLVANIA AVE STE 300
FREDERICKSBURG VA
22408-8605
US

V. Phone/Fax

Practice location:
  • Phone: 540-535-0043
  • Fax: 540-535-0011
Mailing address:
  • Phone: 540-710-6085
  • Fax: 540-710-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000887
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: