Provider Demographics
NPI:1134637077
Name:CONNOLLY, RACHEL (BCABA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 MAGIC HOLLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3010
Mailing Address - Country:US
Mailing Address - Phone:757-639-2218
Mailing Address - Fax:
Practice Address - Street 1:3101 MAGIC HOLLOW BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3010
Practice Address - Country:US
Practice Address - Phone:757-639-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst