Provider Demographics
NPI:1316406325
Name:PROUDLEY, BETHANY NORWOOD (RBT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:NORWOOD
Last Name:PROUDLEY
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 1:4600 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3246
Mailing Address - Country:US
Mailing Address - Phone:804-489-7364
Mailing Address - Fax:
Practice Address - Street 1:4600 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-3246
Practice Address - Country:US
Practice Address - Phone:804-489-7364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician