Provider Demographics
NPI:1457838328
Name:GOAD, KURTIS (BCABA)
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:
Last Name:GOAD
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6442
Mailing Address - Country:US
Mailing Address - Phone:703-229-7034
Mailing Address - Fax:
Practice Address - Street 1:7730 DONEGAN DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2868
Practice Address - Country:US
Practice Address - Phone:571-208-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst