Individual
MR. JOSHUA KENT VICKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.C.A.B.A.
Contact information
Practice address
1651 OLD MEADOW RD, SUITE NUMBER 600, MC LEAN, VA 22102-4311
(800) 828-5659
Mailing address
4425 DIXIE HILL RD, APARTMENT 309, FAIRFAX, VA 22030-9086
(804) 994-4461
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-12-5227
VA
Other
Enumeration date
12/12/2012
Last updated
12/12/2012
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