Healthcare Provider Details

I. General information

NPI: 1003013103
Provider Name (Legal Business Name): CHILDREN'S ADVOCACY CENTER OF CATAWBA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 1ST AVE S
CONOVER NC
28613-2744
US

IV. Provider business mailing address

1007 1ST AVE S
CONOVER NC
28613-2744
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number17053160046003
License Number StateNC

VIII. Authorized Official

Name: DEBORAH ANN JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential: P-LCSW
Phone: 828-465-7664