Provider Demographics
NPI:1568958932
Name:DUDLEY, MARY LINDSAY (RBT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LINDSAY
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 ELECTRIC RD.
Mailing Address - Street 2:BUILDING E SUITE 1B
Mailing Address - City:RONAOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-404-1189
Mailing Address - Fax:
Practice Address - Street 1:3243 ELECTRIC RD.
Practice Address - Street 2:BUILDING E SUITE 1B
Practice Address - City:RONAOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-404-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-18-57965106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician