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General NPI Number Information
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NPI Number | 1427705094
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Entity Type | Organization
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Legal Business Name | LICENSED BEHAVIOR ANALYSIS
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 2280 BROWNSHIRE TRAIL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456
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Country | US
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Telephone | 757-447-0883
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Fax |
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Provider Business Mailing Address
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Address Line | 2280 BROWNSHIRE TRL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-5286
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Country | US
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Telephone | 757-777-5560
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRIS A. JORDAN
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Credential | BCBA/LBA
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Telephone | 757-447-0883
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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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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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