Provider Demographics
NPI:1912558230
Name:TOLJ, EMILY (MED, RBT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TOLJ
Suffix:
Gender:F
Credentials:MED, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 AMORY ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1051
Mailing Address - Country:US
Mailing Address - Phone:857-399-1920
Mailing Address - Fax:
Practice Address - Street 1:400 COALFIELD ROAD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114
Practice Address - Country:US
Practice Address - Phone:804-897-7440
Practice Address - Fax:804-897-7441
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-21-56462103K00000X
VARBT-19-99948106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician