Provider Demographics
NPI:1750907374
Name:CHILDRENS LEARNING TEAM
Entity type:Organization
Organization Name:CHILDRENS LEARNING TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DT
Authorized Official - Phone:870-275-1954
Mailing Address - Street 1:3700 KRISTI LAKE DR APT D11
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8373
Mailing Address - Country:US
Mailing Address - Phone:870-275-1954
Mailing Address - Fax:
Practice Address - Street 1:3700 KRISTI LAKE DR APT D11
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8373
Practice Address - Country:US
Practice Address - Phone:870-275-1954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities