Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1144738071 |
---|---|
Provider Name | Brittany Leah Bollenberg |
First Address | Virginia Beach, VA 23452-1177 |
Second Address | Chesapeake, VA 23321-2154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2018 |
Last Update Date | 30/11/2021 |