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General NPI Number Information
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NPI Number | 1205343209
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Entity Type | Individual
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Provider Name | LORI BEATTY BCABA
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Gender | Female
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 4225 PORTSMOUTH BLVD STE B
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City | CHESAPEAKE
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State | VA
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Zip | 23321-2154
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Country | US
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Telephone | 757-373-2324
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Fax |
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Provider Business Mailing Address
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Address Line | 120 BRAYVIEW DR
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City | MOYOCK
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State | NC
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Zip | 27958-9272
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0134000278
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License Number State | VA
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