Provider Demographics
NPI:1316539208
Name:LIVING AND LEARNING YOUTH CENTER
Entity type:Organization
Organization Name:LIVING AND LEARNING YOUTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTING
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-481-2282
Mailing Address - Street 1:1486 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-9169
Mailing Address - Country:US
Mailing Address - Phone:252-481-2282
Mailing Address - Fax:
Practice Address - Street 1:1486 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-9169
Practice Address - Country:US
Practice Address - Phone:252-481-2282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management