Provider Demographics
NPI:1659993525
Name:GOMES, BRITTANI JACINTA (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANI
Middle Name:JACINTA
Last Name:GOMES
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 OLYMPIA FIELDS PL
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3154
Mailing Address - Country:US
Mailing Address - Phone:571-991-8028
Mailing Address - Fax:
Practice Address - Street 1:50101 GOVERNORS DR STE 170
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9257
Practice Address - Country:US
Practice Address - Phone:919-589-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001529103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst