Provider Demographics
NPI:1902839277
Name:BEHAVIORAL INTERVENTIONS, TRAINING & EVALUATIONS, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL INTERVENTIONS, TRAINING & EVALUATIONS, INC.
Other - Org Name:LISA B. SEDJAT, LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SEDJAT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-416-5325
Mailing Address - Street 1:2108 THOROUGHGOOD RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4015
Mailing Address - Country:US
Mailing Address - Phone:757-416-5325
Mailing Address - Fax:
Practice Address - Street 1:2108 THOROUGHGOOD RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4015
Practice Address - Country:US
Practice Address - Phone:757-416-5325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010156963Medicaid