Provider Demographics
NPI:1417672072
Name:THOMAS, SYDNEE KRISTEN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:SYDNEE
Middle Name:KRISTEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10860 DEPOT DR
Mailing Address - Street 2:
Mailing Address - City:BEALETON
Mailing Address - State:VA
Mailing Address - Zip Code:22712-9395
Mailing Address - Country:US
Mailing Address - Phone:703-975-2505
Mailing Address - Fax:
Practice Address - Street 1:10860 DEPOT DR
Practice Address - Street 2:
Practice Address - City:BEALETON
Practice Address - State:VA
Practice Address - Zip Code:22712-9395
Practice Address - Country:US
Practice Address - Phone:703-975-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-22-61638103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst