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NPI Code Detail

MEDICARE: DAPHNE GILLIAM BCABA

MEDICARE: DAPHNE GILLIAM BCABA
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
1106S00000XBehavior TechnicianRBT-17-33544VA
2106E00000XAssistant Behavior Analyst0134000251VA

General Provider Information

NPI Number : 1326553470
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAPHNE GILLIAM BCABA
Provider Business Mailing Address
First Line : 6850 LEE HWY
Second Line :
City : TROUTVILLE
State : VA
Zip : 24175-5919
Country : US
Telephone Number : 540-580-8790
Fax Number :
Provider Business Practice Location Address
First Line : 1138 2ND ST SW
Second Line :
City : ROANOKE
State : VA
Zip : 24016-4725
Country : US
Telephone Number : 980-785-1113
Fax Number : 980-785-1114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2017
Last Update Date : 02/23/2022

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