Organization
DOMINION ABA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW DOUGLAS WYNN LABA (ASSISTANT BEHAVIOR ANALYST)
(804) 484-4719
Entity
Organization
Contact information
Practice address
2903 BOULEAVARD, COLONIAL HEIGHTS, VA 23834
(804) 484-4719
Mailing address
2903 BOULEVARD, COLONIAL HEIGHTS, VA 23834-2401
(804) 484-4719
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
0-15-6783
VA
Other
Enumeration date
12/07/2015
Last updated
12/07/2015
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