Provider Demographics
NPI:1851654909
Name:DIVERSIFIED CHILDREN YOUTH & FAMILIES DEVELOPMENT PROGRAM
Entity Type:Organization
Organization Name:DIVERSIFIED CHILDREN YOUTH & FAMILIES DEVELOPMENT PROGRAM
Other - Org Name:DIVERSIFIED DEVELOPMENTAL SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-350-7687
Mailing Address - Street 1:7815 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-3462
Mailing Address - Country:US
Mailing Address - Phone:501-350-7687
Mailing Address - Fax:
Practice Address - Street 1:7815 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-3462
Practice Address - Country:US
Practice Address - Phone:501-350-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty