Provider Demographics
NPI:1972112324
Name:VADAN, OCTAVIA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:OCTAVIA
Middle Name:
Last Name:VADAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:OCTAVIA
Other - Middle Name:
Other - Last Name:VEDEANU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5052 PADDY FIELD WAY # A
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6773
Mailing Address - Country:US
Mailing Address - Phone:786-390-3674
Mailing Address - Fax:185-563-1885
Practice Address - Street 1:5052 PADDY FIELD WAY # A
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-6773
Practice Address - Country:US
Practice Address - Phone:786-390-3674
Practice Address - Fax:185-563-1885
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-17-30625106S00000X
SC1-22-59398103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician