Provider Demographics
NPI:1891127650
Name:NOVA ABA
Entity type:Organization
Organization Name:NOVA ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLDATENKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-249-5142
Mailing Address - Street 1:2627 QUINCY ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2436
Mailing Address - Country:US
Mailing Address - Phone:571-249-5142
Mailing Address - Fax:
Practice Address - Street 1:2627 QUINCY ADAMS DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2436
Practice Address - Country:US
Practice Address - Phone:571-249-5142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty