Healthcare Provider Details

I. General information

NPI: 1528237179
Provider Name (Legal Business Name): GENEVA LEARNING CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 WELLINGTON AVE. UNIT H
WILMINGTON NC
28401-7704
US

IV. Provider business mailing address

1606 WELLINGTON AVE. UNIT H
WILMINGTON NC
28401-7704
US

V. Phone/Fax

Practice location:
  • Phone: 910-793-6144
  • Fax: 910-793-6140
Mailing address:
  • Phone: 910-793-6144
  • Fax: 910-793-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3302
License Number StateNC

VIII. Authorized Official

Name: DR. LINDA OLDHAM IKLE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 910-793-6144