| Old Town Aba, Llc | |
|
111 Nevermore Drive Winchester VA 22602 | |
| (703) 727-9417 | |
| Not Available |
| Full Name | Old Town Aba, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 111 Nevermore Drive, Winchester, Virginia |
| Authorized Official Name and Position | Rachel Nicole Evans (OWNER) |
| Authorized Official Contact | 7037279417 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Town Aba, Llc 111 Nevermore Drive Winchester VA 22602 Ph: (703) 727-9417 | Old Town Aba, Llc 111 Nevermore Drive Winchester VA 22602 Ph: (703) 727-9417 |
| NPI Number | 1689257354 |
|---|---|
| Provider Enumeration Date | 04/30/2021 |
| Last Update Date | 04/26/2022 |
| Certification Date | 04/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689257354 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 251C00000X | Day Training, Developmentally Disabled Services | (* (Not Available)) | Secondary |
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