Provider Demographics
NPI:1700243029
Name:HAGOS, SELAMAWIT (LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:SELAMAWIT
Middle Name:
Last Name:HAGOS
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8979 BIRCH BAY CIR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-5660
Mailing Address - Country:US
Mailing Address - Phone:703-994-4754
Mailing Address - Fax:571-384-5815
Practice Address - Street 1:10530 WARWICK AVE
Practice Address - Street 2:SUITE C2
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3132
Practice Address - Country:US
Practice Address - Phone:703-994-4754
Practice Address - Fax:571-384-5815
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst