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General NPI Number Information
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NPI Number | 1619122348
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Entity Type | Organization
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Legal Business Name | POSITIVE BEHAVIOR CONSULTING, LLC
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 5401 BLUE HOLLY CIRCLE
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6539
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Country | US
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Telephone | 804-221-8745
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Fax | 866-864-6286
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Provider Business Mailing Address
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Address Line | P.O. BOX 3767
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City | GLEN ALLEN
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State | VA
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Zip | 23058-3767
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Country | US
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Telephone | 804-221-8745
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Fax | 866-864-6286
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | MR. JUSTIN LEE CREECH
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Credential | BCBA, LMHP, LBA
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Telephone | 804-402-6134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 109
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License Number State | VA
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