Individual
DR. KRISTY LEE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
13962 SAWTEETH WAY, CENTREVILLE, VA 20121-3032
(703) 675-4211
Mailing address
13962 SAWTEETH WAY, CENTREVILLE, VA 20121-3032
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-06-2674
VA
Other
Enumeration date
12/03/2009
Last updated
12/03/2009
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