Provider Demographics
NPI:1497297568
Name:BOEVING, SAMANTHA LEANNE DONALS (BS, BCABA)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEANNE DONALS
Last Name:BOEVING
Suffix:
Gender:F
Credentials:BS, BCABA
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:LEANNE
Other - Last Name:DONALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 RIVER ROCK ARCH
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6155
Mailing Address - Country:US
Mailing Address - Phone:360-362-3718
Mailing Address - Fax:
Practice Address - Street 1:3101 MAGIC HOLLOW BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3010
Practice Address - Country:US
Practice Address - Phone:757-639-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1093009193106S00000X
VA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician