Provider Demographics
NPI:1225497753
Name:EVERS, SUSAN JANE (BCBA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:EVERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5485 RECTOR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3703
Mailing Address - Country:US
Mailing Address - Phone:703-597-8209
Mailing Address - Fax:703-910-4367
Practice Address - Street 1:12656 LAKE RIDGE DR STE C
Practice Address - Street 2:ATT; BEHAVIORAL CONSULTING SERVICES, INC.
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7504
Practice Address - Country:US
Practice Address - Phone:703-597-8209
Practice Address - Fax:703-910-4367
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000712103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst