Provider Demographics
NPI:1114705084
Name:LIFE DEVELOPMENT CENTERS, INCORPORATED
Entity Type:Organization
Organization Name:LIFE DEVELOPMENT CENTERS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
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:937-271-9560
Mailing Address - Street 1:9863 ARN DR
Mailing Address - Street 2:
Mailing Address - City:SUGARCREEK TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4144
Mailing Address - Country:US
Mailing Address - Phone:937-271-9560
Mailing Address - Fax:
Practice Address - Street 1:9863 ARN DR
Practice Address - Street 2:
Practice Address - City:SUGARCREEK TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45458-4144
Practice Address - Country:US
Practice Address - Phone:937-271-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty