Provider Demographics
NPI:1306299599
Name:ROBERSON, MEGHAN BLAIR (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:BLAIR
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:BLAIR
Other - Last Name:GWALTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, CCC/SLP
Mailing Address - Street 1:724 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4745
Mailing Address - Country:US
Mailing Address - Phone:757-377-8156
Mailing Address - Fax:
Practice Address - Street 1:724 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4745
Practice Address - Country:US
Practice Address - Phone:757-377-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000843103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst