Provider Demographics
NPI:1376394700
Name:OBILLO, TRISHA ALLISON MARTIREZ
Entity Type:Individual
Prefix:
First Name:TRISHA ALLISON
Middle Name:MARTIREZ
Last Name:OBILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14428 ALBEMARLE POINT PL STE 150B
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1752
Mailing Address - Country:US
Mailing Address - Phone:703-712-7622
Mailing Address - Fax:
Practice Address - Street 1:14428 ALBEMARLE POINT PL STE 150B
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1752
Practice Address - Country:US
Practice Address - Phone:703-712-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician