Provider Demographics
NPI:1710232152
Name:DAVIDSON, HEATHER JACQUIN (BCBA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JACQUIN
Last Name:DAVIDSON
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 1:3017 PEWTER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6419
Mailing Address - Country:US
Mailing Address - Phone:757-419-9851
Mailing Address - Fax:
Practice Address - Street 1:9351 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-5437
Practice Address - Country:US
Practice Address - Phone:804-596-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000413103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst