Provider Demographics
NPI:1952877870
Name:ROJAS VAZQUEZ, KIMBERLY ANN (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:ROJAS VAZQUEZ
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:ROJAS VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1901 STIRRUP LANE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308
Mailing Address - Country:US
Mailing Address - Phone:706-761-3852
Mailing Address - Fax:
Practice Address - Street 1:12531 CLIPPER DR, SUITE 203
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:571-427-2983
Practice Address - Fax:571-408-4966
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-31773103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst