MEDICARE: RCG BEHAVIORAL HEALTH NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0134000128	VA

General Provider Information

NPI Number	:	1215307301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RCG BEHAVIORAL HEALTH NETWORK

Provider Business Mailing Address
First Line	:	1905 HUGUENOT RD
Second Line	:	SUITE 305
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 HUGUENOT RD
Second Line	:	SUITE 305
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4312
Country	:	US
Telephone Number	:	804-897-1753
Fax Number	:

Authorized Official
Title or Position	:	ABA THERAPIST
Name	:	REBEKAH BROWN
Credential	:	BCABA, LBA
Telephone Number	:	804-404-5237

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	10/01/2015

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