MEDICARE: CALLIE NICOLE FARRAR

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

General Provider Information

NPI Number	:	1376364661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLIE NICOLE FARRAR

Provider Business Mailing Address
First Line	:	300 GAMBRILL CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7212
Country	:	US
Telephone Number	:	406-670-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	2076 S INDEPENDENCE BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4779
Country	:	US
Telephone Number	:	757-622-7272
Fax Number	:

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

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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Directions to “ CALLIE NICOLE FARRAR ” Practice Location

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