Provider Demographics
NPI:1417735226
Name:COLEMAN-HUNTER, KEONA LA'SHA
Entity Type:Individual
Prefix:
First Name:KEONA
Middle Name:LA'SHA
Last Name:COLEMAN-HUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEONA
Other - Middle Name:L
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4128 QUEENSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1808
Mailing Address - Country:US
Mailing Address - Phone:757-323-0137
Mailing Address - Fax:
Practice Address - Street 1:780 LYNNHAVEN PKWY STE 400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7332
Practice Address - Country:US
Practice Address - Phone:877-418-2978
Practice Address - Fax:866-500-2186
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician