Provider Demographics
NPI:1376900647
Name:ISOTOPE BEHAVIORAL LEARNING CENTERS, LLC
Entity Type:Organization
Organization Name:ISOTOPE BEHAVIORAL LEARNING CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-627-5121
Mailing Address - Street 1:177 FIREFLY CV
Mailing Address - Street 2:
Mailing Address - City:LAKE LURE
Mailing Address - State:NC
Mailing Address - Zip Code:28746-8820
Mailing Address - Country:US
Mailing Address - Phone:832-627-5121
Mailing Address - Fax:
Practice Address - Street 1:177 FIREFLY CV
Practice Address - Street 2:
Practice Address - City:LAKE LURE
Practice Address - State:NC
Practice Address - Zip Code:28746-8820
Practice Address - Country:US
Practice Address - Phone:832-627-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty