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General NPI Number Information
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NPI Number | 1003674318
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL SUPPORT SYSTEMS OF VA
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 11551 NUCKOLS RD STE R
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City | GLEN ALLEN
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State | VA
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Zip | 23059-5565
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Country | US
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Telephone | 804-591-6732
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70463
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City | HENRICO
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State | VA
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Zip | 23255-0463
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIN SMYDRA
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Credential | BCBA
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Telephone | 804-591-6732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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