Provider Demographics
NPI:1700214582
Name:EL-EZABY, JOANNA (BCBA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:EL-EZABY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:HOLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:VA BOARD OF MEDICINE
Mailing Address - Street 1:44151 TIPPECANOE TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4917
Mailing Address - Country:US
Mailing Address - Phone:730-593-8630
Mailing Address - Fax:
Practice Address - Street 1:2800 EISENHOWER AVE STE 220
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4587
Practice Address - Country:US
Practice Address - Phone:571-440-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001858103K00000X
VA0134000002106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst