Provider Demographics
NPI:1598271165
Name:DYNMAIK LEARNING, LLC
Entity Type:Organization
Organization Name:DYNMAIK LEARNING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF INNOVATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-497-3661
Mailing Address - Street 1:209 NE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27801-5301
Mailing Address - Country:US
Mailing Address - Phone:252-497-3661
Mailing Address - Fax:
Practice Address - Street 1:209 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-5301
Practice Address - Country:US
Practice Address - Phone:252-497-3661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty