Provider Demographics
NPI:1093031197
Name:WHITE, MEREDITH A (BCBA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:A
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:930 DRIVERS LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9114
Mailing Address - Country:US
Mailing Address - Phone:757-329-6790
Mailing Address - Fax:
Practice Address - Street 1:930 DRIVERS LN
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-9114
Practice Address - Country:US
Practice Address - Phone:757-329-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-09-5713103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst