MEDICARE: ERICA LADD BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-17-27786

General Provider Information

NPI Number	:	1619595741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA LADD BCBA

Provider Business Mailing Address
First Line	:	52 RESERVE DR
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-3744
Country	:	US
Telephone Number	:	314-591-3299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 SPRING FOREST RD STE 206
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-2812
Country	:	US
Telephone Number	:	704-703-8588
Fax Number	:	704-919-5548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	11/02/2023

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