Individual
GENEVA TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10124 W BROAD ST STE A, GLEN ALLEN, VA 23060-3330
(804) 372-0151
(804) 912-2163
Mailing address
10124 W BROAD ST STE A, GLEN ALLEN, VA 23060-3330
(804) 372-0151
(804) 912-2163
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133002753
VA
106E00000X
Assistant Behavior Analyst
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Other
Enumeration date
09/20/2017
Last updated
03/30/2023
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