Provider Demographics
NPI:1366011579
Name:GARCIA-MATA, WHITNEY ANNE (MS BCBA LBA)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ANNE
Last Name:GARCIA-MATA
Suffix:
Gender:F
Credentials:MS BCBA LBA
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:A
Other - Last Name:CLIFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS BCBA LBA
Mailing Address - Street 1:835 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-3177
Mailing Address - Country:US
Mailing Address - Phone:276-229-5072
Mailing Address - Fax:
Practice Address - Street 1:1101 BROOKDALE ST STE B
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4500
Practice Address - Country:US
Practice Address - Phone:276-266-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-17-37753106S00000X
VA1-21-52686103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician