Provider Demographics
NPI:1831858927
Name:LIGHTHOUSE BEHAVIOR ANALYSIS
Entity type:Organization
Organization Name:LIGHTHOUSE BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DALO
Authorized Official - Middle Name:
Authorized Official - Last Name:DURO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, LBA
Authorized Official - Phone:703-851-2618
Mailing Address - Street 1:201 CARTWELL DR APT 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1427
Mailing Address - Country:US
Mailing Address - Phone:703-851-2618
Mailing Address - Fax:
Practice Address - Street 1:201 CARTWELL DR APT 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1427
Practice Address - Country:US
Practice Address - Phone:703-851-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty