Provider Demographics
NPI:1659259471
Name:CUMBERBATCH-SMITH, KAI GRACE
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:GRACE
Last Name:CUMBERBATCH-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 SUMMIT HEIGHTS WAY APT 227
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8428
Mailing Address - Country:US
Mailing Address - Phone:757-550-9118
Mailing Address - Fax:
Practice Address - Street 1:1964 GALLOWS RD STE 280
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3877
Practice Address - Country:US
Practice Address - Phone:571-533-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-25-425256106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician