Provider Demographics
NPI:1497251599
Name:MCLALLEN, CHRISTINE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MCLALLEN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MCCAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9101 WINFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1748
Mailing Address - Country:US
Mailing Address - Phone:330-987-7166
Mailing Address - Fax:
Practice Address - Street 1:3126 W CARY ST # 160
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-3504
Practice Address - Country:US
Practice Address - Phone:804-557-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0-18-8726106E00000X
VARBT-16-14444106S00000X
VA1-18-32686103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician