Basic Information
| Provider Information | |||||||||
| NPI: | 1629682265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | MEGHAN | ||||||||
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| Credential: | PH.D, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 781625 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482781625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143558004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 SOUTHAMPTON AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235101021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576684673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2020 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0810007966 | VA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103K00000X | 0133002734 | VA | N | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.