Individual
MELISSA MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 AMBUSH ST APT 310, YORKTOWN, VA 23693-5679
(631) 901-3711
Mailing address
100 AMBUSH ST APT 310, YORKTOWN, VA 23693-5679
(631) 901-3711
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133001454
VA
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528793189
TRICARE
—
Enumeration date
07/12/2019
Last updated
08/25/2022
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