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General NPI Number Information
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NPI Number | 1205497708
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Entity Type | Individual
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Provider Name | JOHNNIE UNDERWOOD BCBA
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 101 YACHT CT
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5368
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Country | US
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Telephone | 757-660-1074
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Fax |
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Provider Business Mailing Address
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Address Line | 101 YACHT CT
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5368
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Country | US
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Telephone | 757-660-1074
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133000836
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License Number State | VA
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