| Glow Aba Llc | |
|
3612 Stoney Ridge Trail Midlothian VA 23112-4534 | |
| (804) 536-9359 | |
| Not Available |
| Full Name | Glow Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 3612 Stoney Ridge Trail, Midlothian, Virginia |
| Authorized Official Name and Position | Petra Stockhaus (OWNER) |
| Authorized Official Contact | 8044643805 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glow Aba Llc 3612 Stoney Ridge Trl Midlothian VA 23112-4534 Ph: (804) 464-3805 | Glow Aba Llc 3612 Stoney Ridge Trail Midlothian VA 23112-4534 Ph: (804) 536-9359 |
| NPI Number | 1326660242 |
|---|---|
| Provider Enumeration Date | 05/13/2020 |
| Last Update Date | 05/13/2020 |
| Certification Date | 05/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326660242 | NPI | - | NPPES |
| 1053731448 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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