Healthcare Provider Details

I. General information

NPI: 1700505310
Provider Name (Legal Business Name): MR. ERIC ADDERLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 TURTLE CREEK RD APT 4
CHARLOTTESVILLE VA
22901-6737
US

IV. Provider business mailing address

4916 PLANK RD
NORTH GARDEN VA
22959-1613
US

V. Phone/Fax

Practice location:
  • Phone: 434-987-1067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004532
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: