Provider Demographics
NPI:1497309173
Name:WOODS, EBONY N (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:N
Last Name:WOODS
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 EDEN WAY N STE E563
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2798
Mailing Address - Country:US
Mailing Address - Phone:540-915-2114
Mailing Address - Fax:757-951-2731
Practice Address - Street 1:732 EDEN WAY N # E563
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2798
Practice Address - Country:US
Practice Address - Phone:540-915-2114
Practice Address - Fax:757-951-2731
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-21-53687103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1-21-53687Medicaid