Organization
BEHAVIORAL THERAPY & CONSULTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY EAKIN M.S., BCBA (DIRECTOR)
(703) 537-0700
Entity
Organization
Contact information
Practice address
11350 RANDOM HILLS RD STE 240, FAIRFAX, VA 22030-6044
(703) 537-0700
(703) 537-0688
Mailing address
11350 RANDOM HILLS RD STE 240, FAIRFAX, VA 22030-6044
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1084254
VA
Other
Enumeration date
03/22/2011
Last updated
03/22/2011
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