Healthcare Provider Details

I. General information

NPI: 1346810876
Provider Name (Legal Business Name): HEIDI P MEIKLE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 KENNETT PIKE # 988
WILMINGTON DE
19807-2018
US

IV. Provider business mailing address

1651 OLD MEADOW RD STE 600
MC LEAN VA
22102-4389
US

V. Phone/Fax

Practice location:
  • Phone: 484-577-9928
  • Fax:
Mailing address:
  • Phone: 877-504-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: