Provider Demographics
NPI:1265937577
Name:HENDRICKS, LAURA ASHLEY (BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ASHLEY
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 BLOM ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3732
Mailing Address - Country:US
Mailing Address - Phone:443-545-9131
Mailing Address - Fax:
Practice Address - Street 1:2141 PALOMAR AIRPT RD STE 350
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1451
Practice Address - Country:US
Practice Address - Phone:760-438-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst