Provider Demographics
NPI:1710511969
Name:OHANESON, KRISTIN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:OHANESON
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 1:7140 ROYAL FERN CIR APT 404
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-3651
Mailing Address - Country:US
Mailing Address - Phone:571-435-3774
Mailing Address - Fax:
Practice Address - Street 1:7140 ROYAL FERN CIR APT 404
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-3651
Practice Address - Country:US
Practice Address - Phone:571-435-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133001640103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA133001640OtherLBA
1-20-40534OtherBACB