NPIMap

Organization Active NPI

Imagine That Therapy, LLC

  • Behavior Analyst
  • Alexandria, VA
National Provider Identifier
1063192607
Registry record updated Jul 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
IMAGINE THAT THERAPY, LLC
Practice address
1451 Belle Haven Road, #410
Alexandria, VA 22307
Phone
(917) 882-8413
NPI assigned
Jul 19, 2023
Last updated
Jul 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Joanna Bouboulis
Title
Founder
Phone
(917) 882-8413

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X

Addresses

Primary practice location

1451 Belle Haven Road, #410
Alexandria, VA 22307

Mailing address

1451 Belle Haven Rd Ste 410
Alexandria, VA 22307-1201

National Provider Directory

National Provider Directory

Locations

1451 Belle Haven Rd
Ste 410
Alexandria, VA 22307
Phone (703) 634-3532

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1063192607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 BELLE HAVEN RD STE 410",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223071201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 BELLE HAVEN ROAD, #410",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "22307",
            "telephone_number": "917-882-8413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE THAT THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A",
        "authorized_official_last_name": "BOUBOULIS",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "917-882-8413",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.