Healthcare Provider Details

I. General information

NPI: 1740612167
Provider Name (Legal Business Name): WB COMMUNITY LEARNING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 W MANCHESTER BLVD #106
INGLEWOOD CA
90305-2101
US

IV. Provider business mailing address

PO BOX 5604
INGLEWOOD CA
90310-5604
US

V. Phone/Fax

Practice location:
  • Phone: 323-778-7254
  • Fax:
Mailing address:
  • Phone: 323-778-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MISS LOIS MARIE LEBLANC
Title or Position: CEO/ EXECUTIVE DIRECTOR
Credential: DR.
Phone: 323-777-7316