Individual
STEPHANIE PROUTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
9720 CAPITAL CT STE 404, MANASSAS, VA 20110-2052
(855) 910-1148
Mailing address
1157 FARRCROFT WAY, VIRGINIA BEACH, VA 23455-6874
(757) 404-8675
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0134000379
VA
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134000379
—
VA
Enumeration date
06/10/2019
Last updated
02/08/2022
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