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General NPI Number Information
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NPI Number | 1275926776
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Entity Type | Organization
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Legal Business Name | CHILD DEVELOPMENT ASSESSMENT AND THERAPIES
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 2217 PRINCESS ANNE ST 204-1
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3353
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Country | US
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Telephone | 540-940-2858
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Fax |
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Provider Business Mailing Address
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Address Line | 2217 PRINCESS ANNE STREET SUITE 204-1
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City | FREDERICKSBURG
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State | VA
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Zip | 22401
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Country | US
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Telephone | 540-940-2858
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JANET ELIZABETH BLACK
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Credential | M. ED. , BCBA
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Telephone | 540-842-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 23578
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License Number State | VA
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