Provider Demographics
NPI:1043033905
Name:CUBBAGE, SHEREE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:
Last Name:CUBBAGE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:SHEREE
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11743 TURLEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-2624
Mailing Address - Country:US
Mailing Address - Phone:540-271-4343
Mailing Address - Fax:
Practice Address - Street 1:11743 TURLEYTOWN RD
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-2624
Practice Address - Country:US
Practice Address - Phone:540-271-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003975103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst