Provider Demographics
NPI:1942754122
Name:ELGORT, SHAINA MARIE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:MARIE
Last Name:ELGORT
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 LEESBURG PIKE
Mailing Address - Street 2:SUITE 410 EAST
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2004
Mailing Address - Country:US
Mailing Address - Phone:703-506-1930
Mailing Address - Fax:
Practice Address - Street 1:7600 LEESBURG PIKE
Practice Address - Street 2:SUITE 410 EAST
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2004
Practice Address - Country:US
Practice Address - Phone:703-506-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst