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General NPI Number Information
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NPI Number | 1760614382
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Entity Type | Individual
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Provider Name | AMY MICHELLE JAMBA BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 1317 JAMESTOWN RD SUITE 102-B
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-3364
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Country | US
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Telephone | 310-940-8853
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 QUARTERPATH RD SUITE 5A-310
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-6544
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Country | US
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Telephone | 310-940-8853
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0133000146
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License Number State | VA
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