Provider Demographics
NPI:1669794368
Name:EAKIN, KELLY LEE (BCBA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:EAKIN
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 1:12359 SUNRISE VALLEY DR
Mailing Address - Street 2:SUITE 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 1:804 TELEGRAPH RD STE 220
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-4810
Practice Address - Country:US
Practice Address - Phone:571-251-1859
Practice Address - Fax:703-546-1761
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-09-6402103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst