=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013879865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIG HEART ABA VIRGINIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 VAN BUREN ST STE 12056
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20170-5348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-250-9442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 VAN BUREN ST PMB 56 SUITE 120
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-250-9442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ASHER LAX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-250-9442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------