Provider Demographics
NPI:1083338081
Name:MYERS, LADAISHA
Entity Type:Individual
Prefix:
First Name:LADAISHA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N MAIN ST STE 1A2
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2533
Mailing Address - Country:US
Mailing Address - Phone:912-320-4378
Mailing Address - Fax:866-467-4321
Practice Address - Street 1:306 N MAIN ST STE 1A2
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2533
Practice Address - Country:US
Practice Address - Phone:912-320-4378
Practice Address - Fax:866-467-4321
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician