Provider Demographics
NPI:1609578186
Name:PROSPECTIVE SKILLS, LLC
Entity Type:Organization
Organization Name:PROSPECTIVE SKILLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA ,LBA
Authorized Official - Phone:540-424-7721
Mailing Address - Street 1:105 CYPRESS MANOR CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4052
Mailing Address - Country:US
Mailing Address - Phone:540-424-7721
Mailing Address - Fax:
Practice Address - Street 1:104 BASALT DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7228
Practice Address - Country:US
Practice Address - Phone:540-424-7721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336707504Medicaid