Provider Demographics
NPI:1386299071
Name:CONVERGE BEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:CONVERGE BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BADE
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:304-240-9023
Mailing Address - Street 1:11507 HEARTHSTONE CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4403
Mailing Address - Country:US
Mailing Address - Phone:304-240-9023
Mailing Address - Fax:
Practice Address - Street 1:11507 HEARTHSTONE CT
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4403
Practice Address - Country:US
Practice Address - Phone:304-240-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty