Provider Demographics
NPI:1205372570
Name:THE LEAGUE OF EXTRAORDINARY CHILDREN
Entity type:Organization
Organization Name:THE LEAGUE OF EXTRAORDINARY CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-655-8342
Mailing Address - Street 1:6475 EMERALD DUNES DR, UNIT 102
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:843-655-8342
Mailing Address - Fax:
Practice Address - Street 1:6475 EMERALD DUNES DR APT 102
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2770
Practice Address - Country:US
Practice Address - Phone:843-655-8342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health