Provider Demographics
NPI:1609362383
Name:ISRAEL, DUSTIN MARTIN (BCBA, LBA)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:MARTIN
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4725
Mailing Address - Country:US
Mailing Address - Phone:540-312-3133
Mailing Address - Fax:
Practice Address - Street 1:1138 2ND ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4725
Practice Address - Country:US
Practice Address - Phone:540-312-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001160103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty