Provider Demographics
NPI:1114465309
Name:REACHING POTENTIALS VA, LLC
Entity Type:Organization
Organization Name:REACHING POTENTIALS VA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:GORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:561-212-2157
Mailing Address - Street 1:P O BOX 1394
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-1394
Mailing Address - Country:US
Mailing Address - Phone:540-368-8087
Mailing Address - Fax:540-368-8059
Practice Address - Street 1:10707 SPOTSYLVANIA AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2682
Practice Address - Country:US
Practice Address - Phone:540-368-8087
Practice Address - Fax:540-368-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency