Provider Demographics
NPI:1831476472
Name:DECKER, LORENA (BCBA)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:DECKER
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 1:900 TREVOR CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8917
Mailing Address - Country:US
Mailing Address - Phone:252-232-8892
Mailing Address - Fax:252-558-0496
Practice Address - Street 1:900 TREVOR CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8917
Practice Address - Country:US
Practice Address - Phone:252-232-8892
Practice Address - Fax:252-558-0496
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11518427103K00000X
VA0133000595103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst