| Your Life Aba Va, Llc | |
|
1314 Riverland Rd Se Roanoke VA 24014-3610 | |
| (866) 565-7222 | |
| (877) 734-1914 |
| Full Name | Your Life Aba Va, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1314 Riverland Rd Se, Roanoke, Virginia |
| Authorized Official Name and Position | Mark A Yost (GENERAL COUNSEL) |
| Authorized Official Contact | 7182155311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Life Aba Va, Llc 77 Water St Ste 1602 New York NY 10005-4432 Ph: (718) 215-5311 | Your Life Aba Va, Llc 1314 Riverland Rd Se Roanoke VA 24014-3610 Ph: (866) 565-7222 |
| NPI Number | 1023772001 |
|---|---|
| Provider Enumeration Date | 10/26/2021 |
| Last Update Date | 09/05/2024 |
| Certification Date | 09/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023772001 | NPI | - | NPPES |
| 1023772001 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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