Individual
CRYSTAL FIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
331 KEMP LN, CHESAPEAKE, VA 23325-2302
(757) 470-1174
(757) 909-6831
Mailing address
331 KEMP LN, CHESAPEAKE, VA 23325-2302
(757) 470-1174
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133000725
VA
Other
Enumeration date
03/14/2016
Last updated
12/04/2020
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