Provider Demographics
NPI:1003431503
Name:BAILEY, RHIANNON VIOLETTE (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:RHIANNON
Middle Name:VIOLETTE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6515
Mailing Address - Country:US
Mailing Address - Phone:540-283-0035
Mailing Address - Fax:
Practice Address - Street 1:3433 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6515
Practice Address - Country:US
Practice Address - Phone:540-283-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000318106E00000X
VA0133001869103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst