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General NPI Number Information
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NPI Number | 1831858927
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE BEHAVIOR ANALYSIS
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 201 CARTWELL DR APT 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1427
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Country | US
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Telephone | 703-851-2618
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Fax |
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Provider Business Mailing Address
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Address Line | 201 CARTWELL DR APT 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1427
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Country | US
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Telephone | 703-851-2618
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | DALO DURO
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Credential | MA, BCBA, LBA
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Telephone | 703-851-2618
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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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