Individual
GRACE ELIZABETH ADCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10732 S MALL DR APT 725, BATON ROUGE, LA 70809-4819
(225) 229-4734
Mailing address
10732 S MALL DR APT 725, BATON ROUGE, LA 70809-4819
(225) 229-4734
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
LA
106S00000X
Behavior Technician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200605175
BLUE CROSS
LA
01
—
XUP200605175
BLUE CROSS BLUE SHIELD
LA
Enumeration date
01/11/2023
Last updated
01/23/2023
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