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General NPI Number Information
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NPI Number | 1316281355
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL PROGRESS LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 41883 PRECIOUS SQ
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City | ALDIE
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State | VA
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Zip | 20105-3435
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Country | US
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Telephone | 757-575-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 41883 PRECIOUS SQ
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City | ALDIE
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State | VA
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Zip | 20105-3435
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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 | BEHAVIOR ANALYST
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Name | MRS. HOLLY BENNETT
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Credential | M.ED., B.C.B.A.
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Telephone | 757-575-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 0133000080
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License Number State | VA
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