Individual provider Active NPI

Shanika Coleman

  • Behavior Analyst
  • Fayetteville, NC
National Provider Identifier
1669132288
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
3115 Issued in NC
Practice address
2504 Raeford Rd Ste 201
Fayetteville, NC 28305-5135
Phone
(910) 551-3466
NPI assigned
Dec 22, 2021
Last updated
Jul 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 3115 NC Primary
Assistant Behavior Analyst 106E00000X A1208 NC
Behavior Technician 106S00000X

Addresses

Primary practice location

2504 Raeford Rd Ste 201
Fayetteville, NC 28305-5135

Mailing address

4611 Duncastle Rd Apt 3B
Fayetteville, NC 28314-1656
Phone (985) 772-2991

Other practice location 1

1018 N Bragg Blvd
Spring Lake, NC 28390-3316
Phone (910) 295-2609

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3115NCMDBehavioral Analyst
A1208NCMDAssistant Behavior Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
JJD Learning Academy Behavior Analyst CurrentSince Aug 17, 2025 Accepting new patients

Locations

2504 Raeford Rd
Ste 201
Fayetteville, NC 28305
Phone (910) 651-0131

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1669132288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4611 DUNCASTLE RD APT 3B",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141656",
            "telephone_number": "985-772-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 RAEFORD RD STE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055135",
            "telephone_number": "910-551-3466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1018 N Bragg Blvd",
            "address_purpose": "LOCATION",
            "city": "Spring Lake",
            "state": "NC",
            "postal_code": "283903316",
            "country_code": "US",
            "telephone_number": "910-295-2609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "SHANIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-22",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "3115",
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "NC",
            "license": "A1208",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.