Provider Demographics
NPI:1215253174
Name:YOUNKINS, ANDREA DAWN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:YOUNKINS
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 1:4532 NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4925
Mailing Address - Country:US
Mailing Address - Phone:757-651-2655
Mailing Address - Fax:757-606-3131
Practice Address - Street 1:4532 NORMAN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-4925
Practice Address - Country:US
Practice Address - Phone:757-651-2655
Practice Address - Fax:757-606-3131
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-09-6039103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst