Provider Demographics
NPI:1720557630
Name:ELLINGTON, RACHAEL (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 NEWLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1907
Mailing Address - Country:US
Mailing Address - Phone:804-986-3860
Mailing Address - Fax:
Practice Address - Street 1:10912 NEWLANDS AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1907
Practice Address - Country:US
Practice Address - Phone:804-986-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001257103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst