Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst | ||
Y | 106S00000X | Behavior Technician |
NPI | 1164055232 |
---|---|
Provider Name | Stephan Nessim Al-Khateeb |
First Address | Fairfax, VA 22030-7475 |
Second Address | Fairfax, VA 22030-7475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2020 |
Last Update Date | 04/03/2020 |