1811359623 NPI number — JANA LEIGH DILLON M.ED., BCBA, LBA

Table of content: JANA LEIGH DILLON M.ED., BCBA, LBA (NPI 1811359623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811359623 NPI number — JANA LEIGH DILLON M.ED., BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLON
Provider First Name:
JANA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LESHLEY
Provider Other First Name:
JANA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., BCBA, LBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811359623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 MAGIC HOLLOW BLVD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23453-3010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-639-2218
Provider Business Mailing Address Fax Number:
866-594-3899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 MAGIC HOLLOW BLVD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-639-2218
Provider Business Practice Location Address Fax Number:
866-594-3899
Provider Enumeration Date:
03/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  0133000747 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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