Provider Demographics
NPI:1043666837
Name:RAINES, KELCIE NOELANI (MS, BCBA, LBA)
Entity type:Individual
Prefix:MS
First Name:KELCIE
Middle Name:NOELANI
Last Name:RAINES
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:MS
Other - First Name:KELCIE
Other - Middle Name:NOELANI
Other - Last Name:AWO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:21191 VINELAND SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5463
Mailing Address - Country:US
Mailing Address - Phone:808-729-1706
Mailing Address - Fax:
Practice Address - Street 1:21191 VINELAND SQ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5463
Practice Address - Country:US
Practice Address - Phone:808-729-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-347103K00000X
WABA61366827103K00000X
VA013303112103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst