Healthcare Provider Details

I. General information

NPI: 1780829697
Provider Name (Legal Business Name): CHILDREN'S ADVOCACY CENTER OF CATAWBA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 COUNTY HOME ROAD
CONOVER NC
28613
US

IV. Provider business mailing address

4360 COUNTY HOME ROAD
CONOVER NC
28613
US

V. Phone/Fax

Practice location:
  • Phone: 828-465-9296
  • Fax: 828-256-7711
Mailing address:
  • Phone: 828-465-9296
  • Fax: 828-256-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1828
License Number StateNC

VIII. Authorized Official

Name: ADRIENNE OPDYKE
Title or Position: EXECUTIVE DIRECTOR
Credential: EXECUTIVE DIRECTOR
Phone: 828-465-7665