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General NPI Number Information
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NPI Number | 1578226890
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC INNOVATIONS ABA LLC
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 2011 MAYFLOWER DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2322
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Country | US
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Telephone | 740-359-5984
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Fax |
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Provider Business Mailing Address
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Address Line | 2011 MAYFLOWER DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2322
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Country | US
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Telephone | 740-359-5984
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JAIME JEFFERS
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Credential | MA
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Telephone | 740-359-5624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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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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