Healthcare Provider Details

I. General information

NPI: 1942032594
Provider Name (Legal Business Name): JJD LEARNING ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 RAEFORD RD STE 201
FAYETTEVILLE NC
28305-5135
US

IV. Provider business mailing address

2504 RAEFORD RD STE 201
FAYETTEVILLE NC
28305-5135
US

V. Phone/Fax

Practice location:
  • Phone: 910-916-3261
  • Fax:
Mailing address:
  • Phone: 910-916-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SHANIKA COLEMAN
Title or Position: OWNER
Credential:
Phone: 985-772-2991