Provider Demographics
NPI:1700534948
Name:STUCKEY, AALYAH RENEE (RBT)
Entity Type:Individual
Prefix:
First Name:AALYAH
Middle Name:RENEE
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 ARBUTUS AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1208
Mailing Address - Country:US
Mailing Address - Phone:540-761-2292
Mailing Address - Fax:
Practice Address - Street 1:1112 2ND ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4711
Practice Address - Country:US
Practice Address - Phone:540-215-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-22-205399103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst