Provider Demographics
NPI:1629329206
Name:HOPRICH, LISSA DAWN (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LISSA
Middle Name:DAWN
Last Name:HOPRICH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 KINGS CREST DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5114
Mailing Address - Country:US
Mailing Address - Phone:540-588-9582
Mailing Address - Fax:540-380-8155
Practice Address - Street 1:1301 KINGS CREST DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5114
Practice Address - Country:US
Practice Address - Phone:540-588-9582
Practice Address - Fax:540-380-8155
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-11-9221103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst