Provider Demographics
NPI:1962834853
Name:PROGRESSIVE ABA, INC.
Entity type:Organization
Organization Name:PROGRESSIVE ABA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RAULERSON-KELLAS
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA, LABA
Authorized Official - Phone:757-869-4162
Mailing Address - Street 1:12727 MCMANUS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4459
Mailing Address - Country:US
Mailing Address - Phone:757-877-2300
Mailing Address - Fax:757-264-6258
Practice Address - Street 1:12727 MCMANUS BLVD STE G
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4459
Practice Address - Country:US
Practice Address - Phone:757-877-2300
Practice Address - Fax:757-264-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000030103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty