Provider Demographics
NPI:1104408012
Name:THODE, MARISA LEE (BCBA,LBA)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:LEE
Last Name:THODE
Suffix:
Gender:F
Credentials:BCBA,LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 HOOF CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-8550
Mailing Address - Country:US
Mailing Address - Phone:219-902-0013
Mailing Address - Fax:
Practice Address - Street 1:1108 EDEN WAY N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3339
Practice Address - Country:US
Practice Address - Phone:219-902-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA21162116106S00000X
VA1-23-63698103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician