Organization
TINY TADPOLES BEHAVIORAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RECAIRDO DEMETRIUS MANGRUM M.ED., BCBA (DIRECTOR)
(570) 713-9112
Entity
Organization
Contact information
Practice address
14060 BIG CREST LN APT 403, WOODBRIDGE, VA 22191-5537
(570) 713-9112
Mailing address
14060 BIG CREST LN APT 403, WOODBRIDGE, VA 22191-5537
(570) 713-9112
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
VA
Other
Enumeration date
05/21/2013
Last updated
05/21/2013
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