Healthcare Provider Details

I. General information

NPI: 1497801591
Provider Name (Legal Business Name): ELIZABETH K LADD ED. D, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5789 BATTLEFIELD PKWY
RINGGOLD GA
30736-5154
US

IV. Provider business mailing address

5789 BATTLEFIELD PKWY
RINGGOLD GA
30736-5154
US

V. Phone/Fax

Practice location:
  • Phone: 423-451-2111
  • Fax:
Mailing address:
  • Phone: 423-451-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY002841
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY002841
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY002841
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number82-07P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: