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General NPI Number Information
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NPI Number | 1659180826
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Entity Type | Organization
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Legal Business Name | BLUE GEMS ABA THERAPY VA LLC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 8280 WILLOW OAKS CORPORATE DR STE 600
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City | FAIRFAX
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State | VA
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Zip | 22031-4516
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Country | US
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Telephone | 571-370-4734
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Fax |
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Provider Business Mailing Address
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Address Line | 101 EISENHOWER PKWY STE 300
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City | ROSELAND
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State | NJ
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Zip | 07068-1054
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID WOLF
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Credential |
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Telephone | 617-297-7998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #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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