Provider Demographics
NPI:1710577044
Name:BEHAVIORAL EMPOWERMENT COACHING, PLLC
Entity Type:Organization
Organization Name:BEHAVIORAL EMPOWERMENT COACHING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/CREATOR/CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, LBA, RDT
Authorized Official - Phone:757-639-0512
Mailing Address - Street 1:604 GRAYDON AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1734
Mailing Address - Country:US
Mailing Address - Phone:757-639-0512
Mailing Address - Fax:804-589-4501
Practice Address - Street 1:604 GRAYDON AVE APT 8
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1734
Practice Address - Country:US
Practice Address - Phone:757-639-0512
Practice Address - Fax:804-589-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1538609300Medicaid