Organization
GLOW ABA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETRA STOCKHAUS M.ED., BCBA, LBA (OWNER)
(804) 464-3805
Entity
Organization
Contact information
Practice address
3612 STONEY RIDGE TRAIL, MIDLOTHIAN, VA 23112-4534
(804) 536-9359
Mailing address
3612 STONEY RIDGE TRL, MIDLOTHIAN, VA 23112-4534
(804) 464-3805
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053731448
—
VA
Enumeration date
05/13/2020
Last updated
05/13/2020
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