Provider Demographics
NPI:1215511449
Name:PEELE, KATRINA K (RBT, BA)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:K
Last Name:PEELE
Suffix:
Gender:F
Credentials:RBT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 GLENOAK DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3164
Mailing Address - Country:US
Mailing Address - Phone:757-635-5832
Mailing Address - Fax:
Practice Address - Street 1:780 LYNNHAVEN PKWY # 250
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7332
Practice Address - Country:US
Practice Address - Phone:757-301-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-137326106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician