Provider Demographics
NPI:1083837900
Name:LIFE DEVELOPMENT CENTERS, INCORPORATED
Entity Type:Organization
Organization Name:LIFE DEVELOPMENT CENTERS, INCORPORATED
Other - Org Name:STEPHEN W. EMERICK PH.D. AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:EMERICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:937-434-2100
Mailing Address - Street 1:7071 CORPORATE WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-8911
Mailing Address - Country:US
Mailing Address - Phone:937-434-2100
Mailing Address - Fax:937-439-3747
Practice Address - Street 1:7071 CORPORATE WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-8911
Practice Address - Country:US
Practice Address - Phone:937-434-2100
Practice Address - Fax:937-439-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4189103T00000X
OH90281103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0738027Medicaid
OHR71474Medicare UPIN
OH0738027Medicaid