Provider Demographics
NPI:1073751293
Name:BEHAVIOR CHANGE INCORPORATED
Entity Type:Organization
Organization Name:BEHAVIOR CHANGE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDESTY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:804-519-1360
Mailing Address - Street 1:2126 E BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2041
Mailing Address - Country:US
Mailing Address - Phone:804-519-1360
Mailing Address - Fax:
Practice Address - Street 1:2126 E BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-2041
Practice Address - Country:US
Practice Address - Phone:804-519-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1062931305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service