| Blue Water Aba Therapy, Co | |
|
5472 Kings Dr Gloucester VA 23061-2906 | |
| (804) 824-2396 | |
| (804) 824-2397 |
| Full Name | Blue Water Aba Therapy, Co |
|---|---|
| Speciality | Behavior Analyst |
| Location | 5472 Kings Dr, Gloucester, Virginia |
| Authorized Official Name and Position | Heidi Lynn Callis (OWNER/BCBA) |
| Authorized Official Contact | 8048242396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Water Aba Therapy, Co 5472 Kings Dr Gloucester VA 23061-2906 Ph: (804) 824-2396 | Blue Water Aba Therapy, Co 5472 Kings Dr Gloucester VA 23061-2906 Ph: (804) 824-2396 |
| NPI Number | 1033602552 |
|---|---|
| Provider Enumeration Date | 06/09/2018 |
| Last Update Date | 10/25/2020 |
| Certification Date | 10/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033602552 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 0133000500 (Virginia) | Primary |
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