| Grace Aba Llc | |
|
372 Belgrave Rd Newport News VA 23602-6403 | |
| (719) 459-8374 | |
| (757) 282-2597 |
| Full Name | Grace Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 372 Belgrave Rd, Newport News, Virginia |
| Authorized Official Name and Position | Lynette Jacobs (BCBA) |
| Authorized Official Contact | 7194598374 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Aba Llc 372 Belgrave Rd Newport News VA 23602-6403 Ph: (719) 459-8374 | Grace Aba Llc 372 Belgrave Rd Newport News VA 23602-6403 Ph: (719) 459-8374 |
| NPI Number | 1356833974 |
|---|---|
| Provider Enumeration Date | 05/30/2018 |
| Last Update Date | 09/23/2022 |
| Certification Date | 09/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356833974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 0133000785 (Virginia) | Primary |
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