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General NPI Number Information
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NPI Number | 1780491332
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Entity Type | Organization
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Legal Business Name | SOUTHAMPTON BEHAVIOR THERAPY LLC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 21635 COBB POND DR
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City | COURTLAND
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State | VA
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Zip | 23837-2196
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Country | US
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Telephone | 863-837-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 21635 COBB POND DR
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City | COURTLAND
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State | VA
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Zip | 23837-2196
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Country | US
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Telephone | 863-837-8007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEISHA KLINE
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Credential | MA, BCBA, LBA
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Telephone | 863-837-8007
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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 |
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License Number State |
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