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General NPI Number Information
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NPI Number | 1396300844
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Entity Type | Individual
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Provider Name | QIANA SANDERS
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Gender | Female
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 5606 VIRGINIA BEACH BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5631
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Country | US
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Telephone | 891-107-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 2597 PENSHURST WAY
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-7850
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Country | US
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Telephone | 757-309-3397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-83754
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License Number State | VA
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