| Providence Community Aba | |
|
22 Kassy Ln Stafford VA 22556-6577 | |
| (253) 722-9152 | |
| Not Available |
| Full Name | Providence Community Aba |
|---|---|
| Speciality | Behavior Analyst |
| Location | 22 Kassy Ln, Stafford, Virginia |
| Authorized Official Name and Position | Bridget L Nkematabong (MANAGER) |
| Authorized Official Contact | 2537229152 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Community Aba 5614 Joshua Tree Cir Fredericksburg VA 22407-9341 Ph: () - | Providence Community Aba 22 Kassy Ln Stafford VA 22556-6577 Ph: (253) 722-9152 |
| NPI Number | 1902570443 |
|---|---|
| Provider Enumeration Date | 08/08/2021 |
| Last Update Date | 01/23/2024 |
| Certification Date | 01/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902570443 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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