Organization
BLUE WATER ABA THERAPY, CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI LYNN CALLIS BCBA (OWNER/BCBA)
(804) 824-2396
Entity
Organization
Contact information
Practice address
5472 KINGS DR, GLOUCESTER, VA 23061-2906
(804) 824-2396
(804) 824-2397
Mailing address
5472 KINGS DR, GLOUCESTER, VA 23061-2906
(804) 824-2396
(804) 824-2397
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133000500
VA
Other
Enumeration date
06/09/2018
Last updated
10/25/2020
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