Provider Demographics
NPI:1588175137
Name:STEPHANIE M. HADLEY
Entity type:Organization
Organization Name:STEPHANIE M. HADLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:757-777-6652
Mailing Address - Street 1:933 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8723
Mailing Address - Country:US
Mailing Address - Phone:757-777-6652
Mailing Address - Fax:303-262-6901
Practice Address - Street 1:933 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8723
Practice Address - Country:US
Practice Address - Phone:757-777-6652
Practice Address - Fax:303-262-6901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHANIE M. HADLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000385103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174810154OtherOTHER EMPLOYEE NPI