=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588304224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYLA THORNTON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2022
-----------------------------------------------------
Last Update Date | 09/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4141 N HENDERSON RD STE 7&8
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22203-2486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-777-9210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 CINDY LN
-----------------------------------------------------
City | CAPITOL HEIGHTS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20743-2556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-990-7709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------