Healthcare Provider Details

I. General information

NPI: 1629682265
Provider Name (Legal Business Name): MEGHAN COLEMAN PH.D, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 GRESHAM DR
NORFOLK VA
23507
US

IV. Provider business mailing address

401 GRESHAM DR
NORFOLK VA
23507
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4673
  • Fax:
Mailing address:
  • Phone: 757-668-4673
  • Fax: 757-668-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002734
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007966
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: