Provider Demographics
NPI:1710348339
Name:LUMAPATHS BEHAVIORAL SERVICES, PLLC.
Entity Type:Organization
Organization Name:LUMAPATHS BEHAVIORAL SERVICES, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MAT, BCBA, LBA
Authorized Official - Phone:757-932-9057
Mailing Address - Street 1:629 PHOENIX DR STE 115
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7392
Mailing Address - Country:US
Mailing Address - Phone:757-932-9057
Mailing Address - Fax:757-743-9004
Practice Address - Street 1:629 PHOENIX DR STE 115
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7392
Practice Address - Country:US
Practice Address - Phone:757-932-9057
Practice Address - Fax:757-743-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000525103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty