NPIMap

Stephan Nessim Al-Khateeb, M.ED.

Individual provider Active NPI Behavior Technician · Fairfax, VA

NPI 1164055232 · NPPES record last updated Mar 4, 2020

Key facts

NPI
1164055232
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
11200 Waples Mill Rd Ste 100
Fairfax, VA 22030-7475
Phone
(571) 585-3999
NPI assigned
Feb 18, 2020
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Education

Practice roles

OrganizationSpecialtyStatusNew patients
Axiom Link, Inc. Behavior Technician Past
since Mar 9, 2020		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Assistant Behavior Analyst 106E00000X
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

11200 Waples Mill Rd Ste 100
Fairfax, VA 22030-7475

Mailing address

11200 Waples Mill Rd Ste 100
Fairfax, VA 22030-7475
Phone (571) 585-3999

Other practice location 1

11240 Waples Mill Rd Ste 101
Fairfax, VA 22030-6078
Phone (703) 237-2219

Other practice location 2

11200 Waples Mill Rd Ste 200
Fairfax, VA 22030-7551
Phone (703) 237-2219

Other providers in Fairfax, VA

All providers in Fairfax, VA · Behavior Technician in Virginia

Sources for this page

Verify at the official NPI Registry.