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General NPI Number Information
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NPI Number | 1235504671
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Entity Type | Organization
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Legal Business Name | PENNINGTON GROUP FULL SPECTRUM SERVICES
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 561 STERLING RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-2025
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Country | US
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Telephone | 757-472-1930
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Fax |
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Provider Business Mailing Address
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Address Line | 561 STERLING RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-2025
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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 | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | MS. SUZANNA MYERS
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Credential | BCBA, LBA
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Telephone | 757-472-1930
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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 | 0133000512
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License Number State | VA
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