Provider Demographics
NPI:1871130633
Name:LIVERS, ANGELA LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:LIVERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 CENTRAL BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2818
Mailing Address - Country:US
Mailing Address - Phone:757-644-6391
Mailing Address - Fax:757-622-2011
Practice Address - Street 1:7460 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2818
Practice Address - Country:US
Practice Address - Phone:757-644-6391
Practice Address - Fax:757-622-2011
Is Sole Proprietor?:No
Enumeration Date:2019-11-28
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001734103K00000X
VA0134000294106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst