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General NPI Number Information
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NPI Number | 1396010906
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Entity Type | Individual
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Provider Name | AMANDA GAYLE RICKARD BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 102 ELIZABETH ST SUITE C
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5676
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Country | US
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Telephone | 910-333-0814
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Fax | 910-333-0817
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Provider Business Mailing Address
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Address Line | 102 ELIZABETH ST. SUITE C
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City | JACKSONVILLE
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State | NC
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Zip | 28540
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Country | US
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Telephone | 910-333-0814
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Fax | 910-333-0817
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-1013
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License Number State | NC
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