Provider Demographics
NPI:1821689357
Name:CHILD DEVELOPMENT CONSULTANTS, LLC
Entity Type:Organization
Organization Name:CHILD DEVELOPMENT CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-216-5710
Mailing Address - Street 1:107 UPLAND TER
Mailing Address - Street 2:
Mailing Address - City:WAVERLY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 UPLAND TER
Practice Address - Street 2:
Practice Address - City:WAVERLY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8983
Practice Address - Country:US
Practice Address - Phone:404-216-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health