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General NPI Number Information
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NPI Number | 1093264657
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MOMENTUM, LLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 574 EDMONTON TER NE
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City | LEESBURG
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State | VA
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Zip | 20176-1829
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Country | US
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Telephone | 443-540-0120
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Fax |
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Provider Business Mailing Address
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Address Line | 574 EDMONTON TER NE
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City | LEESBURG
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State | VA
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Zip | 20176-1829
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Country | US
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Telephone | 443-540-0120
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | KATHERINE WILCOX
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Credential | BCBA
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Telephone | 443-540-0120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 133000306
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License Number State | VA
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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 | 133000306
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License Number State | VA
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