Healthcare Provider Details

I. General information

NPI: 1699248815
Provider Name (Legal Business Name): BUILDING BLOCKS BEHAVIORAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N LEWIS ST
LAGRANGE GA
30240-2740
US

IV. Provider business mailing address

PO BOX 154
LAGRANGE GA
30241-0003
US

V. Phone/Fax

Practice location:
  • Phone: 706-298-6381
  • Fax: 866-812-9807
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PAULETTE DUKES
Title or Position: OWNER
Credential: CCC, SLP
Phone: 706-302-9695