Provider Demographics
NPI:1689981714
Name:COLLEGE LIVING EXPERIENCE
Entity Type:Organization
Organization Name:COLLEGE LIVING EXPERIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D
Authorized Official - Phone:949-270-1233
Mailing Address - Street 1:2183 FAIRVIEW RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5663
Mailing Address - Country:US
Mailing Address - Phone:949-270-1234
Mailing Address - Fax:949-270-1240
Practice Address - Street 1:25 SPECTRUM POINTE DR
Practice Address - Street 2:SUITE 405
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2276
Practice Address - Country:US
Practice Address - Phone:949-939-8032
Practice Address - Fax:949-457-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-01-0418103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty