Provider Demographics
NPI:1881168227
Name:REECE, ANNETTE SANDRA (LBA, BCBA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:SANDRA
Last Name:REECE
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-3846
Mailing Address - Country:US
Mailing Address - Phone:276-274-3888
Mailing Address - Fax:
Practice Address - Street 1:107 MELROSE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-3846
Practice Address - Country:US
Practice Address - Phone:276-274-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-33601103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-33601OtherBEHAVIOR ANALYST CERTIFICATION BOARD
VA0133001301OtherVIRGINIA DEPARTMENT OF HEALTH