Provider Demographics
NPI:1700438488
Name:INGENITO, RICHIA (BS, BCABA, LABA)
Entity Type:Individual
Prefix:
First Name:RICHIA
Middle Name:
Last Name:INGENITO
Suffix:
Gender:F
Credentials:BS, BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12711 GORDON BLVD APT 77
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2655
Mailing Address - Country:US
Mailing Address - Phone:571-383-5156
Mailing Address - Fax:
Practice Address - Street 1:7617 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2645
Practice Address - Country:US
Practice Address - Phone:703-639-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0199787106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst