MEDICARE: CINDLE VANGORDER 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	103K00000X	Behavior Analyst	BCBA734125	VA

General Provider Information

NPI Number	:	1316693849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDLE VANGORDER RBT

Provider Business Mailing Address
First Line	:	200 FARMINGTON RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4040
Country	:	US
Telephone Number	:	330-209-5912
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 FARMINGTON RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4040
Country	:	US
Telephone Number	:	330-209-5912
Fax Number	:

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

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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Directions to “ CINDLE VANGORDER RBT” Practice Location

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