Provider Demographics
NPI:1700435146
Name:CROSBY, DYLAN KEITH
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:KEITH
Last Name:CROSBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N HENDERSON RD STE 8
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2485
Mailing Address - Country:US
Mailing Address - Phone:540-771-0149
Mailing Address - Fax:
Practice Address - Street 1:1018 S QUEBEC ST APT 4
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4155
Practice Address - Country:US
Practice Address - Phone:540-771-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician