Provider Demographics
NPI:1740691864
Name:WADDELL, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WADDELL
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 1:903 BLUE LEAF COURT
Mailing Address - Street 2:UNIT M
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:571-426-4203
Mailing Address - Fax:
Practice Address - Street 1:801 CHILDRENS CENTER RD SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2545
Practice Address - Country:US
Practice Address - Phone:703-777-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst