Individual
CRYSTAL AMY COLLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., BCBA, LBA
Contact information
Practice address
1354 8TH ST SW, ROANOKE, VA 24015-1812
(434) 363-5306
Mailing address
1354 8TH ST SW, ROANOKE, VA 24015-1812
(434) 363-5306
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133000276
VA
103K00000X
Behavior Analyst
1-11-8012
—
Other
Enumeration date
10/10/2011
Last updated
04/08/2015
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