Provider Demographics
NPI:1689334898
Name:CHU, LINDA KIM (RBT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KIM
Last Name:CHU
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 BIG BEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8582
Mailing Address - Country:US
Mailing Address - Phone:540-388-6533
Mailing Address - Fax:
Practice Address - Street 1:1701 FALL HILL AVE STE 105
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3570
Practice Address - Country:US
Practice Address - Phone:540-899-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-198036106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician