Active NPI
Mark Anthony Wilson Jr.
- Behavior Technician
- Chesapeake, VA
National Provider Identifier
1740177179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-25-443737
- Practice address
- 611 Station Square CT
Chesapeake, VA 23320-0705 - Phone
- (757) 895-2673
- NPI assigned
- Jun 19, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-25-443737 | VA | Primary |
Addresses
Primary practice location
611 Station Square CT
Chesapeake, VA 23320-0705
Mailing address
28 George CT
Hampton, VA 23663-2046
Phone (757) 239-0606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-25-443737 | VA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dom ABA Services LLC | Current | Accepting new patients |
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.
-
- Behavior Analyst
- Chesapeake, VA
- NPI 1912587585
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750291200000",
"number": "1740177179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 GEORGE CT",
"city": "HAMPTON",
"state": "VA",
"postal_code": "236632046",
"telephone_number": "757-239-0606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 STATION SQUARE CT",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233200705",
"telephone_number": "757-895-2673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MARK",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-06-19",
"last_updated": "2025-06-19",
"certification_date": "2025-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "VA",
"license": "RBT-25-443737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.