Provider Demographics
NPI:1194180273
Name:ENOCH, MARY RACHEL (BCBA, LBA)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:RACHEL
Last Name:ENOCH
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 KENSINGTON AVE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2457
Mailing Address - Country:US
Mailing Address - Phone:785-565-8148
Mailing Address - Fax:
Practice Address - Street 1:11311 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3199
Practice Address - Country:US
Practice Address - Phone:804-378-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000655103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst