Provider Demographics
NPI:1902560899
Name:KEARNEY GRAHAM, CHRISTINE (BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KEARNEY GRAHAM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 AMALFI CT
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-5816
Mailing Address - Country:US
Mailing Address - Phone:703-431-3772
Mailing Address - Fax:
Practice Address - Street 1:105 AMALFI CT
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-5816
Practice Address - Country:US
Practice Address - Phone:703-431-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002137103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst