Provider Demographics
NPI:1871060996
Name:FRIDAY, LAURA (BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FRIDAY
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 1:7212 POMPANO PL
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-4403
Mailing Address - Country:US
Mailing Address - Phone:843-251-6001
Mailing Address - Fax:
Practice Address - Street 1:9800 KINCEY AVE STE 160
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8402
Practice Address - Country:US
Practice Address - Phone:704-708-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-17-28207103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst