Provider Demographics
NPI:1639594872
Name:ZEGOWITZ, ELIZABETH (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ZEGOWITZ
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1851
Mailing Address - Country:US
Mailing Address - Phone:704-522-9912
Mailing Address - Fax:
Practice Address - Street 1:1462 S GREENMOUNT DR
Practice Address - Street 2:APT 404
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-2306
Practice Address - Country:US
Practice Address - Phone:804-920-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-16-23849103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst