Provider Demographics
NPI:1376242859
Name:HICKORY LEARNING GROUP LLC
Entity Type:Organization
Organization Name:HICKORY LEARNING GROUP LLC
Other - Org Name:HICKORY LEARNING GROUP LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:828-459-6003
Mailing Address - Street 1:3628 26TH STREET DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7206
Mailing Address - Country:US
Mailing Address - Phone:201-264-2570
Mailing Address - Fax:
Practice Address - Street 1:3628 26TH STREET DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-7206
Practice Address - Country:US
Practice Address - Phone:828-459-6003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty