=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417616186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERSECTIONS IN ADVOCACY CONSULTATIVE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2021
-----------------------------------------------------
Last Update Date | 12/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 PEAR AVE
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23607-5523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-645-8879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 COLISEUM XING # 5028
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-5971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-645-8879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH BELL
-----------------------------------------------------
Credential | BCBA, LBA
-----------------------------------------------------
Telephone | 757-645-8879
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------