Provider Demographics
NPI:1700505310
Name:ADDERLEY, ERIC
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:ADDERLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GARDEN
Mailing Address - State:VA
Mailing Address - Zip Code:22959-1613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 TURTLE CREEK RD APT 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-6737
Practice Address - Country:US
Practice Address - Phone:434-987-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician