Provider Demographics
NPI:1841434172
Name:LIFE CHALLENGES ADOLESCENT TRAINING & TREATMENT ACADEMY
Entity type:Organization
Organization Name:LIFE CHALLENGES ADOLESCENT TRAINING & TREATMENT ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:DEVONNE
Authorized Official - Last Name:SHANKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-739-2764
Mailing Address - Street 1:1127 BETHLEHEM RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-8280
Mailing Address - Country:US
Mailing Address - Phone:704-739-2764
Mailing Address - Fax:704-734-1107
Practice Address - Street 1:1127 BETHLEHEM RD
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-8280
Practice Address - Country:US
Practice Address - Phone:704-739-2764
Practice Address - Fax:704-734-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children