=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831820935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANGUAGE BRIDGES ABA THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2022
-----------------------------------------------------
Last Update Date | 04/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4437 BROOKFIELD CORPORATE DR STE 203
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-225-9365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4437 BROOKFIELD CORPORATE DR STE 203
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-225-9365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
-----------------------------------------------------
Name | MOUNIA CHAFFAI MELLOUKI
-----------------------------------------------------
Credential | LBA
-----------------------------------------------------
Telephone | 703-225-9365
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------