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10302 Bristow Center Dr Suite 62 Bristow VA 20136-2201 | |
| (703) 393-1989 | |
| (703) 656-4880 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 10302 Bristow Center Dr, Bristow, Virginia |
| Authorized Official Name and Position | Rebecca Clayton (CEO) |
| Authorized Official Contact | 7033931989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10302 Bristow Center Dr Suite 62 Bristow VA 20136-2201 Ph: (703) 393-1989 | 10302 Bristow Center Dr Suite 62 Bristow VA 20136-2201 Ph: (703) 393-1989 |
| NPI Number | 1437506698 |
|---|---|
| Provider Enumeration Date | 05/18/2016 |
| Last Update Date | 05/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437506698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-12-12387 (Pennsylvania) | Primary |
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