Provider Demographics
NPI:1548933492
Name:MYERS, LUA E (RBT)
Entity type:Individual
Prefix:MS
First Name:LUA
Middle Name:E
Last Name:MYERS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 CLEAR SPRING RD # B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-3050
Mailing Address - Country:US
Mailing Address - Phone:301-305-0277
Mailing Address - Fax:
Practice Address - Street 1:13509 COLDWATER DR
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5408
Practice Address - Country:US
Practice Address - Phone:202-262-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-21-160458106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician