Provider Demographics
NPI:1437822566
Name:BLACKWELL, HEATHER STOWE (BCBA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:STOWE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARISA
Other - Last Name:STOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-24-73390103K00000X
ALRBT-18-62981106S00000X
NC0-23-14756106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst