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General NPI Number Information
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NPI Number | 1326784422
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Entity Type | Organization
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Legal Business Name | LUMINOUS ABA, LLC
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 921 CHALBOURNE DR
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City | CHESAPEAKE
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State | VA
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Zip | 23322-9004
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Country | US
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Telephone | 757-774-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 921 CHALBOURNE DR
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City | CHESAPEAKE
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State | VA
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Zip | 23322-9004
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Country | US
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Telephone | 757-774-3011
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | MRS. DEBORAH ANN HERNANDEZ
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Credential | BCBA
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Telephone | 757-774-3011
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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 |
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License Number State |
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