Provider Demographics
NPI:1720876246
Name:BECKER, SADIE ADELLE
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:ADELLE
Last Name:BECKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10803 MAIN ST STE 700
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4728
Mailing Address - Country:US
Mailing Address - Phone:571-212-6627
Mailing Address - Fax:
Practice Address - Street 1:10803 MAIN ST STE 700
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4728
Practice Address - Country:US
Practice Address - Phone:571-212-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABACB885411106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician