Provider Demographics
NPI:1558456962
Name:INNOVATIVE BEHAVIOR TREATMENT CENTERS
Entity Type:Organization
Organization Name:INNOVATIVE BEHAVIOR TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OFEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-914-0466
Mailing Address - Street 1:6800 VERSAR CENTER DRIVE, SUITE 402B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151
Mailing Address - Country:US
Mailing Address - Phone:703-914-0466
Mailing Address - Fax:703-914-0498
Practice Address - Street 1:6800 VERSAR CENTER DRIVE, SUITE 402B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151
Practice Address - Country:US
Practice Address - Phone:703-914-0466
Practice Address - Fax:703-914-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty