Provider Demographics
NPI:1962891788
Name:MEADOWS, DELIONEL B SR
Entity type:Individual
Prefix:MR
First Name:DELIONEL
Middle Name:B
Last Name:MEADOWS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18011 SUTERSMILL WAY
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-4571
Mailing Address - Country:US
Mailing Address - Phone:703-686-4764
Mailing Address - Fax:
Practice Address - Street 1:18011 SUTERSMILL WAY
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-4571
Practice Address - Country:US
Practice Address - Phone:703-686-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0175378659Medicaid
VA0174891272Medicaid