Provider Demographics
NPI:1003499732
Name:SEASIDE ABA THERAPY, LLC
Entity Type:Organization
Organization Name:SEASIDE ABA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:SIEGEL
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:757-235-0997
Mailing Address - Street 1:3212 LORTON CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7014
Mailing Address - Country:US
Mailing Address - Phone:757-575-6820
Mailing Address - Fax:
Practice Address - Street 1:3212 LORTON CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7014
Practice Address - Country:US
Practice Address - Phone:757-575-6820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty