Organization
PROVIDENCE COMMUNITY ABA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIDGET L NKEMATABONG (MANAGER)
(253) 722-9152
Entity
Organization
Contact information
Practice address
22 KASSY LN, STAFFORD, VA 22556-6577
(253) 722-9152
Mailing address
5614 JOSHUA TREE CIR, FREDERICKSBURG, VA 22407-9341
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/08/2021
Last updated
01/23/2024
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