Provider Demographics
NPI:1194203653
Name:LOVING, KEVIN SCOTT (ASSISTANT BEHAVIOR A)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
Last Name:LOVING
Suffix:
Gender:M
Credentials:ASSISTANT BEHAVIOR A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 WINDING ASH PL
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2610
Mailing Address - Country:US
Mailing Address - Phone:804-937-0955
Mailing Address - Fax:
Practice Address - Street 1:10128 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3300
Practice Address - Country:US
Practice Address - Phone:804-744-1114
Practice Address - Fax:804-893-3721
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000230103K00000X
VA0133001287103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst