=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306512413
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLINE HILBURGER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2021
-----------------------------------------------------
Last Update Date | 08/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22375 BRODERICK DR STE 125
-----------------------------------------------------
City | DULLES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20166-9345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-375-0214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20725 WOOD QUAY DR UNIT 262
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20166-7069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-371-1312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-21-176396
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------