Provider Demographics
NPI:1528346210
Name:C LINC
Entity type:Organization
Organization Name:C LINC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:RICKIE LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCLS
Authorized Official - Phone:702-277-2247
Mailing Address - Street 1:3407 CALLE ODESSA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8625
Mailing Address - Country:US
Mailing Address - Phone:702-277-2247
Mailing Address - Fax:
Practice Address - Street 1:3407 CALLE ODESSA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8625
Practice Address - Country:US
Practice Address - Phone:702-277-2247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty