Provider Demographics
NPI:1760018600
Name:CROOKSHANK, HEATHER ASHWORTH (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ASHWORTH
Last Name:CROOKSHANK
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:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:EMORY
Mailing Address - State:VA
Mailing Address - Zip Code:24327-0941
Mailing Address - Country:US
Mailing Address - Phone:276-623-7557
Mailing Address - Fax:
Practice Address - Street 1:426 ARNOLD ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2228
Practice Address - Country:US
Practice Address - Phone:276-623-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251C00000XAgenciesDay Training, Developmentally Disabled Services