Provider Demographics
NPI:1760897730
Name:CALLIS, HEIDI LYNN (BCBA)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LYNN
Last Name:CALLIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5472 KINGS DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-2906
Mailing Address - Country:US
Mailing Address - Phone:804-824-2396
Mailing Address - Fax:804-824-2397
Practice Address - Street 1:5472 KINGS DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-2906
Practice Address - Country:US
Practice Address - Phone:804-824-2396
Practice Address - Fax:804-824-2397
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA0-14-10205103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst