Provider Demographics
NPI:1801301106
Name:FARLEY, CARLA JANAI
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JANAI
Last Name:FARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 S. RANDOLPH STREET
Mailing Address - Street 2:ARLINGTON
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4822
Mailing Address - Country:US
Mailing Address - Phone:703-477-2501
Mailing Address - Fax:
Practice Address - Street 1:3152 ANCHORWAY CT
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-7549
Practice Address - Country:US
Practice Address - Phone:703-477-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-1509527106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-15-09527OtherBACB