Organization
SUPPORTIVE CARE ABA VA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUBEN KESHERIM (MEMBER)
(317) 936-1240
Entity
Organization
Contact information
Practice address
1765 GREENSBORO STATION PL, MC LEAN, VA 22102-3467
(317) 936-1240
(317) 936-1241
Mailing address
1765 GREENSBORO STATION PL, MC LEAN, VA 22102-3467
(317) 936-1240
(317) 936-1241
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/22/2022
Last updated
10/31/2024
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