Provider Demographics
NPI:1356073399
Name:STANSBERRY, ZACHARY BRYCE (BCBA, LBA)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:BRYCE
Last Name:STANSBERRY
Suffix:
Gender:M
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 1:4811 ADAIR AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1601
Mailing Address - Country:US
Mailing Address - Phone:804-274-8491
Mailing Address - Fax:
Practice Address - Street 1:1701 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2201
Practice Address - Country:US
Practice Address - Phone:804-269-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002524103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst