Healthcare Provider Details

I. General information

NPI: 1033755467
Provider Name (Legal Business Name): MADELINE HARPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date: 06/02/2025
Reactivation Date: 11/07/2025

III. Provider practice location address

132 CASTILIAN DR
VIRGINIA BEACH VA
23462-7638
US

IV. Provider business mailing address

132 CASTILIAN DR
VIRGINIA BEACH VA
23462-7638
US

V. Phone/Fax

Practice location:
  • Phone: 970-573-2420
  • Fax:
Mailing address:
  • Phone: 970-573-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73624
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: