Healthcare Provider Details

I. General information

NPI: 1902411150
Provider Name (Legal Business Name): LEAH JOY IDICHANDY MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 FAYETTEVILLE RD STE 100
RALEIGH NC
27603-3602
US

IV. Provider business mailing address

328 HACKSAW TRL
RALEIGH NC
27610-9729
US

V. Phone/Fax

Practice location:
  • Phone: 919-827-0560
  • Fax:
Mailing address:
  • Phone: 678-575-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number604
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: