Provider Demographics
NPI:1871031484
Name:DHIRAPRASIDDHI, LISA MICHELLE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELLE
Last Name:DHIRAPRASIDDHI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:UHLEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8390 SIX FORKS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3060
Mailing Address - Country:US
Mailing Address - Phone:919-890-5852
Mailing Address - Fax:919-896-6443
Practice Address - Street 1:8390 SIX FORKS RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3060
Practice Address - Country:US
Practice Address - Phone:919-890-5852
Practice Address - Fax:919-896-6443
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-20933103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst