Provider Demographics
NPI:1003142290
Name:ASSOCIATED BEHAVORIAL OUTCOMES AND DEVELOPMENTAL EXPERTS OF VIRGINIA
Entity Type:Organization
Organization Name:ASSOCIATED BEHAVORIAL OUTCOMES AND DEVELOPMENTAL EXPERTS OF VIRGINIA
Other - Org Name:VABODE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:NMI
Authorized Official - Last Name:SYMEONIDES
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:804-244-0802
Mailing Address - Street 1:PO BOX 28289
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228
Mailing Address - Country:US
Mailing Address - Phone:804-864-2273
Mailing Address - Fax:804-726-2273
Practice Address - Street 1:8659 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228
Practice Address - Country:US
Practice Address - Phone:804-864-2273
Practice Address - Fax:804-726-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
VA97703001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427105063Medicaid