Provider Demographics
NPI:1598279895
Name:CRAIG, SHELBY ELIZABETH (M ED, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:CRAIG
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10124 W BROAD ST STE A
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3330
Mailing Address - Country:US
Mailing Address - Phone:804-372-0151
Mailing Address - Fax:804-912-2163
Practice Address - Street 1:10124 W BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3330
Practice Address - Country:US
Practice Address - Phone:804-372-0151
Practice Address - Fax:804-912-2163
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000912103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst