Provider Demographics
NPI:1669729182
Name:KIRBY, MEGAN ERIN SULLIVAN (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ERIN SULLIVAN
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ERIN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11311 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3199
Mailing Address - Country:US
Mailing Address - Phone:804-378-6141
Mailing Address - Fax:804-378-6183
Practice Address - Street 1:11311 BUSINESS CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3199
Practice Address - Country:US
Practice Address - Phone:804-378-6141
Practice Address - Fax:804-378-6183
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-12-11756103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst