Provider Demographics
NPI:1235635442
Name:PHELPS, ARISA (RBT)
Entity Type:Individual
Prefix:
First Name:ARISA
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2583
Mailing Address - Country:US
Mailing Address - Phone:757-664-9778
Mailing Address - Fax:757-903-0114
Practice Address - Street 1:2206 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2583
Practice Address - Country:US
Practice Address - Phone:757-664-9778
Practice Address - Fax:757-903-0114
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-18-52759106S00000X
VA1-23-67512103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician