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General NPI Number Information
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NPI Number | 1861218364
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Entity Type | Individual
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Provider Name | TIMOTHY HENRIQUEZ
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Gender | Male
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Dates
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Enumeration Date | 11/29/2024
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 188 OVILLE RD
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City | STAFFORD
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State | VA
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Zip | 22556
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Country | US
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Telephone | 540-645-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 507 SANTEE DR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-2812
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Country | US
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Telephone | 540-505-1394
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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 | RBT-24-395251
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License Number State |
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