NPIMap

Organization Active NPI

Spectrum Transformation Group, LLC

  • Behavior Analyst
  • North Chesterfield, VA
National Provider Identifier
1639560741
Registry record updated Mar 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
161707010 Issued in VA
Legal business name
SPECTRUM TRANSFORMATION GROUP, LLC
Practice address
221 Stonebridge Plaza Ave Ste C
North Chesterfield, VA 23225-6972
Phone
(804) 378-6141
NPI assigned
Feb 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2020

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

Authorized official

Name
Dr. Cedric A Moore Jr.
Title
President and Ceo
Phone
(804) 378-6141

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X 161707010 VA Primary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X VA
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X VA

Addresses

Primary practice location

221 Stonebridge Plaza Ave Ste C
North Chesterfield, VA 23225-6972

Mailing address

221 Stonebridge Plaza Ave Ste C
North Chesterfield, VA 23225-6972

Other practice location 1

1721 S High St
Harrisonburg, VA 22801-1553
Phone (540) 908-2441

Other identifiers 1

IdentifierTypeStateIssuer
1174855985OtherVANPI

Other names 1

  • Spectrum Transformation Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Spectrum Transformation Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

370 Neff Ave
Ste F
Harrisonburg, VA 22801
Phone (540) 908-2441

11311 Business Center Dr
Ste C
North Chesterfield, VA 23236
Phone (804) 378-6141

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585008000000",
    "number": "1639560741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 STONEBRIDGE PLAZA AVE STE C",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232256972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 STONEBRIDGE PLAZA AVE STE C",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232256972",
            "telephone_number": "804-378-6141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1721 S High St",
            "address_purpose": "LOCATION",
            "city": "Harrisonburg",
            "state": "VA",
            "postal_code": "228011553",
            "country_code": "US",
            "telephone_number": "540-908-2441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECTRUM TRANSFORMATION GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "CEDRIC",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "804-378-6141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "161707010",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "VA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1174855985",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Transformation Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Transformation Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; 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.