Provider Demographics
NPI:1972112324
Name:VADAN, OCTAVIA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:OCTAVIA
Middle Name:
Last Name:VADAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:OCTAVIA
Other - Middle Name:
Other - Last Name:VEDEANU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2070 NORTHBROOK BLVD STE B4
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9254
Mailing Address - Country:US
Mailing Address - Phone:843-569-3033
Mailing Address - Fax:843-569-6820
Practice Address - Street 1:2070 NORTHBROOK BLVD STE B4
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9254
Practice Address - Country:US
Practice Address - Phone:843-569-3033
Practice Address - Fax:843-569-6820
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-22-59398103K00000X
SCRBT-17-30625106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician