Provider Demographics
NPI:1619122348
Name:POSITIVE BEHAVIOR CONSULTING, LLC
Entity Type:Organization
Organization Name:POSITIVE BEHAVIOR CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LMHP, LBA
Authorized Official - Phone:804-402-6134
Mailing Address - Street 1:P.O. BOX 3767
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-3767
Mailing Address - Country:US
Mailing Address - Phone:804-221-8745
Mailing Address - Fax:866-864-6286
Practice Address - Street 1:5401 BLUE HOLLY CIRCLE
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6539
Practice Address - Country:US
Practice Address - Phone:804-221-8745
Practice Address - Fax:866-864-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA109103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010297796Medicaid
VA010297796Medicaid