=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174965321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | APRIL SMITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2013
-----------------------------------------------------
Last Update Date | 05/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9420 WORTHINGTON DR
-----------------------------------------------------
City | BRISTOW
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20136-5756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-354-0040
-----------------------------------------------------
Fax | 267-859-0171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8870 RIXLEW LN STE 101
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20109-3795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-354-0040
-----------------------------------------------------
Fax | 571-522-2705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106E00000X
-----------------------------------------------------
Taxonomy Name | Assistant Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 0134000045
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------