Provider Demographics
NPI:1396010906
Name:RICKARD, AMANDA GAYLE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GAYLE
Last Name:RICKARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 ELIZABETH ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540
Mailing Address - Country:US
Mailing Address - Phone:910-333-0814
Mailing Address - Fax:910-333-0817
Practice Address - Street 1:102 ELIZABETH ST
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5676
Practice Address - Country:US
Practice Address - Phone:910-333-0814
Practice Address - Fax:910-333-0817
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-12-1013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst