Provider Demographics
NPI:1164072658
Name:GEORGE, TERI DIANE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:DIANE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:DIANE
Other - Last Name:CLEMENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1820 CASTLETON CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5765
Mailing Address - Country:US
Mailing Address - Phone:757-778-3895
Mailing Address - Fax:
Practice Address - Street 1:1820 CASTLETON CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5765
Practice Address - Country:US
Practice Address - Phone:757-778-3895
Practice Address - Fax:888-356-3082
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001492103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst