Dominion ABA

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

0-15-6783 Issued in VA

Legal business name

DOMINION ABA

Practice address

2903 Bouleavard
Colonial Heights, VA 23834

Phone

(804) 484-4719

NPI assigned

Dec 7, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Douglas Wynn, LABA

Title

Assistant Behavior Analyst

Phone

(804) 484-4719

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1449446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449446400000",
    "number": "1134594864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2903 BOULEVARD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238342401",
            "telephone_number": "804-484-4719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2903 BOULEAVARD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "23834",
            "telephone_number": "804-484-4719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION ABA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-07",
        "last_updated": "2015-12-07",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "ASSISTANT BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "804-484-4719",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LABA"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "VA",
            "license": "0-15-6783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John L Ditto, MD
• Bryan Lee Dixon, DDS
• Kevin Richard Dmytriw, MD
• Thinh DO, PHARMD
• Mark A Doloresco, MD
• Dominion Heart and Vascular Clinic
• Douglas Avery & Associates LTD
• Dr Shaw S Lee PC
• Dr. Phillip Y Shou PC
• Sedina Drake

• Early Intervention Provider Agency in Colonial Heights, VA
• Providers in Colonial Heights, VA by specialty
• Early Intervention Provider Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; 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.