Provider Demographics
NPI:1700437357
Name:PRESTON, KELSEY (MAT, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
Credentials:MAT, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42371 PIPER CREEK TER
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4936
Mailing Address - Country:US
Mailing Address - Phone:571-263-0038
Mailing Address - Fax:
Practice Address - Street 1:42371 PIPER CREEK TER
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-4936
Practice Address - Country:US
Practice Address - Phone:571-263-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst