Provider Demographics
NPI:1104702117
Name:PROGRESSIVE BEHAVIOR SUPPORT PLLC
Entity type:Organization
Organization Name:PROGRESSIVE BEHAVIOR SUPPORT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-676-9162
Mailing Address - Street 1:814 ARBOLEDA DR
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-1595
Mailing Address - Country:US
Mailing Address - Phone:757-676-9162
Mailing Address - Fax:
Practice Address - Street 1:814 ARBOLEDA DR
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-1595
Practice Address - Country:US
Practice Address - Phone:757-676-9162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health