Provider Demographics
NPI:1265900443
Name:INDEPENDENCE COMMUNITY LEARNING CENTER, LLC.
Entity type:Organization
Organization Name:INDEPENDENCE COMMUNITY LEARNING CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TREMATRICE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, LBA
Authorized Official - Phone:225-245-0334
Mailing Address - Street 1:7135 KENT DR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-5235
Mailing Address - Country:US
Mailing Address - Phone:225-245-0334
Mailing Address - Fax:
Practice Address - Street 1:7135 KENT DR
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-5235
Practice Address - Country:US
Practice Address - Phone:225-245-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty