Provider Demographics
NPI:1578156600
Name:MCFADDEN, JESSICA (BCABA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 SCARBOROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3049
Mailing Address - Country:US
Mailing Address - Phone:757-387-2211
Mailing Address - Fax:
Practice Address - Street 1:1409 KEMPSVILLE RD # RC
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8134
Practice Address - Country:US
Practice Address - Phone:757-578-8608
Practice Address - Fax:757-416-6483
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000523106E00000X
106S00000X
VA0133003443103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician