Provider Demographics
NPI:1043920010
Name:GLADDEN, STEPHANIE CHRISTINE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:GLADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W JUBAL EARLY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6508
Mailing Address - Country:US
Mailing Address - Phone:540-931-5805
Mailing Address - Fax:
Practice Address - Street 1:500 W JUBAL EARLY DR STE 200
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6508
Practice Address - Country:US
Practice Address - Phone:540-431-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-141155103K00000X, 106S00000X
VA0-24-14999106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT63157040OtherDMV