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General NPI Number Information
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NPI Number | 1285907576
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Entity Type | Organization
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Legal Business Name | ACTS FOR BEHAVIORAL CHANGE, LLC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 43863 AMITY PL
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City | ASHBURN
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State | VA
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Zip | 20147-3801
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Country | US
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Telephone | 703-729-5710
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Fax | 703-729-5710
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Provider Business Mailing Address
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Address Line | 43863 AMITY PL
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City | ASHBURN
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State | VA
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Zip | 20147-3801
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Country | US
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Telephone | 703-729-5710
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Fax | 703-729-5710
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. DIANA M COFFMAN
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Credential | BCBA
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Telephone | 703-729-5710
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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 | 1095594
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License Number State |
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