Provider Demographics
NPI:1831732486
Name:DRIVEN BEHAVIORAL SUPPORT LLC
Entity type:Organization
Organization Name:DRIVEN BEHAVIORAL SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:MONDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:540-479-7823
Mailing Address - Street 1:10468 INVESTORS PL STE B
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1749
Mailing Address - Country:US
Mailing Address - Phone:540-479-7823
Mailing Address - Fax:540-301-8315
Practice Address - Street 1:10468 INVESTORS PL STE B
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1749
Practice Address - Country:US
Practice Address - Phone:540-479-7823
Practice Address - Fax:540-301-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty