Provider Demographics
NPI:1649746397
Name:LYONS, QUITIBILLA L (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:QUITIBILLA
Middle Name:L
Last Name:LYONS
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 1:1215 SIMMS PL NE APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7824
Mailing Address - Country:US
Mailing Address - Phone:240-426-9002
Mailing Address - Fax:
Practice Address - Street 1:1215 SIMMS PL NE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7824
Practice Address - Country:US
Practice Address - Phone:240-426-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA325103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst