Provider Demographics
NPI:1396284469
Name:COX, SHELLEY ANN
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:ANN
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:14619 ALGRETUS DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1330
Mailing Address - Country:US
Mailing Address - Phone:703-231-0555
Mailing Address - Fax:
Practice Address - Street 1:14619 ALGRETUS DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1330
Practice Address - Country:US
Practice Address - Phone:703-231-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT 16 25184106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARBT 16 25184OtherBACB