Provider Demographics
NPI:1710253943
Name:DEVELOPMENT LEARNING CENTER OF ST LUCIE COUNTY FLORIDA INC
Entity Type:Organization
Organization Name:DEVELOPMENT LEARNING CENTER OF ST LUCIE COUNTY FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MAULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:772-871-7800
Mailing Address - Street 1:2423 TAMARIND DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34949-1544
Mailing Address - Country:US
Mailing Address - Phone:772-979-5515
Mailing Address - Fax:772-335-5855
Practice Address - Street 1:2550 SE WALTON RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7168
Practice Address - Country:US
Practice Address - Phone:772-979-5515
Practice Address - Fax:772-335-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty