Provider Demographics
NPI:1154813855
Name:FENTRESS, ALEKSANDRA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ALEKSANDRA
Middle Name:
Last Name:FENTRESS
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 1:611 STATION SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0705
Mailing Address - Country:US
Mailing Address - Phone:757-895-2673
Mailing Address - Fax:
Practice Address - Street 1:611 STATION SQUARE CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0705
Practice Address - Country:US
Practice Address - Phone:757-895-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0133001924OtherSTATE LISENCE