Provider Demographics
NPI:1295059418
Name:BEHAVIORAL THERAPY AND CONSULTATION VA LLC
Entity type:Organization
Organization Name:BEHAVIORAL THERAPY AND CONSULTATION VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:571-251-1859
Mailing Address - Street 1:12359 SUNRISE VALLEY DR
Mailing Address - Street 2:220
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3462
Mailing Address - Country:US
Mailing Address - Phone:571-251-1859
Mailing Address - Fax:703-441-7814
Practice Address - Street 1:3073 ANTRIM CIR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-3319
Practice Address - Country:US
Practice Address - Phone:571-251-1859
Practice Address - Fax:703-441-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-09-6402252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency