Provider Demographics
NPI:1629351689
Name:BEHAVIOR INTERVENTION OF VIRGINIA
Entity Type:Organization
Organization Name:BEHAVIOR INTERVENTION OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:ILORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-937-1941
Mailing Address - Street 1:211 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-6415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 TURNER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-6415
Practice Address - Country:US
Practice Address - Phone:804-937-1941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health