Provider Demographics
NPI:1740949510
Name:HARRELSON, ANDREW PAUL (BCABA, LABA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
Last Name:HARRELSON
Suffix:
Gender:M
Credentials:BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MACPHERSON CIR APT 312
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4202
Mailing Address - Country:US
Mailing Address - Phone:804-929-2130
Mailing Address - Fax:
Practice Address - Street 1:221 STONEBRIDGE PLAZA AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-6972
Practice Address - Country:US
Practice Address - Phone:804-378-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000409106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty