=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841888047
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TREASURED HEARTS ABA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2021
-----------------------------------------------------
Last Update Date | 04/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12512 SHERWOOD FOREST DR
-----------------------------------------------------
City | CULPEPER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22701-1663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-538-7316
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18025 GRAND PROSPERITY DR
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34293-4966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-596-2237
-----------------------------------------------------
Fax | 540-744-1091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MRS. PAMELA LYN REZA
-----------------------------------------------------
Credential | BCBA, LBA
-----------------------------------------------------
Telephone | 540-538-6618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------