Provider Demographics
NPI:1407158397
Name:BARNES, CAROLYN DEE (BCBA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DEE
Last Name:BARNES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 DOLINA DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8268
Mailing Address - Country:US
Mailing Address - Phone:757-679-8777
Mailing Address - Fax:
Practice Address - Street 1:1932 DOLINA DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-8268
Practice Address - Country:US
Practice Address - Phone:757-679-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-27
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-10-7539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst