Provider Demographics
NPI:1568772069
Name:NEXT STEP DEVELOPMENTAL LEARNING, LLC
Entity Type:Organization
Organization Name:NEXT STEP DEVELOPMENTAL LEARNING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:BETHEA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-920-2661
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-0394
Mailing Address - Country:US
Mailing Address - Phone:910-920-2661
Mailing Address - Fax:910-920-2660
Practice Address - Street 1:2504 RAEFORD RD
Practice Address - Street 2:SUITE 113
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5294
Practice Address - Country:US
Practice Address - Phone:910-797-0410
Practice Address - Fax:910-920-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200377Medicaid