Provider Demographics
NPI:1437481660
Name:COFFMAN, DIANA MARIE (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:MISS
Other - First Name:DIANA
Other - Middle Name:MARIE
Other - Last Name:TRANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43863 AMITY PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3801
Mailing Address - Country:US
Mailing Address - Phone:703-729-5710
Mailing Address - Fax:
Practice Address - Street 1:43863 AMITY PL
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3801
Practice Address - Country:US
Practice Address - Phone:703-729-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-09-55-94103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA$$$$$$$$$OtherTRICARE RENDERING NUMBER