Provider Demographics
NPI:1710489513
Name:WOLRIDGE, EDRECKA
Entity Type:Individual
Prefix:
First Name:EDRECKA
Middle Name:
Last Name:WOLRIDGE
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 1:4103 W DELHI AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3419
Mailing Address - Country:US
Mailing Address - Phone:702-578-1978
Mailing Address - Fax:
Practice Address - Street 1:4103 W DELHI AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3419
Practice Address - Country:US
Practice Address - Phone:702-578-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst