MEDICARE: ARISA PHELPS RBT

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	106S00000X	Behavior Technician	RBT-18-52759	GA
2	103K00000X	Behavior Analyst	1-23-67512	VA

General Provider Information

NPI Number	:	1235635442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARISA PHELPS RBT

Provider Business Mailing Address
First Line	:	2206 EXECUTIVE DR STE A
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2583
Country	:	US
Telephone Number	:	757-664-9778
Fax Number	:	757-903-0114

Provider Business Practice Location Address
First Line	:	2206 EXECUTIVE DR STE A
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2583
Country	:	US
Telephone Number	:	757-664-9778
Fax Number	:	757-903-0114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	08/14/2023

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Directions to “ ARISA PHELPS RBT” Practice Location

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