Provider Demographics
NPI:1780835595
Name:ALLSUP, ELAINE (M ED, BCBA)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:ALLSUP
Suffix:
Gender:F
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43178 ALLENBY WAY
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6473
Mailing Address - Country:US
Mailing Address - Phone:703-338-7750
Mailing Address - Fax:703-669-9060
Practice Address - Street 1:43178 ALLENBY WAY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6473
Practice Address - Country:US
Practice Address - Phone:703-338-7750
Practice Address - Fax:703-669-9060
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-04-2056103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst