Provider Demographics
NPI:1861159121
Name:AUSTIN-VILLANUEVA, ROBERT III (BCABA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:AUSTIN-VILLANUEVA
Suffix:III
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 WATERFORD LAKE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3994
Mailing Address - Country:US
Mailing Address - Phone:804-658-4509
Mailing Address - Fax:
Practice Address - Street 1:8000 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1338
Practice Address - Country:US
Practice Address - Phone:804-521-5579
Practice Address - Fax:804-553-3310
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0-21-13178106E00000X
VARBT-21-161513106S00000X
VA0133004029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician