Provider Demographics
NPI:1639506066
Name:FOOTPRINTS BEHAVIOR SERVICES LLC
Entity Type:Organization
Organization Name:FOOTPRINTS BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LEAD BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:703-216-2572
Mailing Address - Street 1:5878 ORCHARD HILL CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-1064
Mailing Address - Country:US
Mailing Address - Phone:703-216-2572
Mailing Address - Fax:703-825-1290
Practice Address - Street 1:5878 ORCHARD HILL CT
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-1064
Practice Address - Country:US
Practice Address - Phone:703-216-2572
Practice Address - Fax:703-825-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty