Provider Demographics
NPI:1205309069
Name:RANDOLPH, MEGHAN ANDREA (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANDREA
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 EDEN WAY NORTH #178
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-450-8507
Mailing Address - Fax:757-585-3544
Practice Address - Street 1:2909 SAVILLE GARDEN WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-7032
Practice Address - Country:US
Practice Address - Phone:757-450-8507
Practice Address - Fax:757-585-3544
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst