Provider Demographics
NPI:1083204697
Name:TRANQUILL, KARRAH RUTH (RBT)
Entity Type:Individual
Prefix:
First Name:KARRAH
Middle Name:RUTH
Last Name:TRANQUILL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NORFOLK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7232
Mailing Address - Country:US
Mailing Address - Phone:540-419-7280
Mailing Address - Fax:
Practice Address - Street 1:1701 FALL HILL AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3571
Practice Address - Country:US
Practice Address - Phone:540-899-5790
Practice Address - Fax:866-499-8840
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-133719106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician