Provider Demographics
NPI:1871092700
Name:NORTHERN VIRGINIA INSTRUCTIONAL CONSULTING, LLC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA INSTRUCTIONAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:571-247-8689
Mailing Address - Street 1:4120 DOVEVILLE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1446
Mailing Address - Country:US
Mailing Address - Phone:571-247-8689
Mailing Address - Fax:
Practice Address - Street 1:4120 DOVEVILLE LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1446
Practice Address - Country:US
Practice Address - Phone:571-247-8689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000216103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty