Provider Demographics
NPI:1528572294
Name:COLEMAN, ISMA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ISMA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9379 FORESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4760
Mailing Address - Country:US
Mailing Address - Phone:703-945-8609
Mailing Address - Fax:
Practice Address - Street 1:9379 FORESTWOOD LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4760
Practice Address - Country:US
Practice Address - Phone:703-945-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002599103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0133002599OtherLBA
VA1-22-60289OtherBCBA