Provider Demographics
NPI:1598350167
Name:ALBA, CRYSTAL DENISE (RBT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DENISE
Last Name:ALBA
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 1:10832 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4841
Mailing Address - Country:US
Mailing Address - Phone:571-839-5704
Mailing Address - Fax:
Practice Address - Street 1:12531 CLIPPER DR STE 203
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2355
Practice Address - Country:US
Practice Address - Phone:571-839-5704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-17-41819106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician