Provider Demographics
NPI:1598388597
Name:DONG, XIN (BCBA)
Entity Type:Individual
Prefix:DR
First Name:XIN
Middle Name:
Last Name:DONG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 HARVEY RD APT 534
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-6738
Mailing Address - Country:US
Mailing Address - Phone:979-213-3246
Mailing Address - Fax:
Practice Address - Street 1:633 E FERNHURST DR STE 801
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1587
Practice Address - Country:US
Practice Address - Phone:979-627-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3352103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst