Provider Demographics
NPI:1497801591
Name:LADD, ELIZABETH K (ED D, PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:LADD
Suffix:
Gender:F
Credentials:ED D, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5789 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5154
Mailing Address - Country:US
Mailing Address - Phone:423-451-2111
Mailing Address - Fax:
Practice Address - Street 1:5789 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5154
Practice Address - Country:US
Practice Address - Phone:423-451-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002841103TC1900X, 103T00000X, 103TB0200X
AR82-07P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA194550280AMedicaid