Healthcare Provider Details

I. General information

NPI: 1497089742
Provider Name (Legal Business Name): ECU CHILD DEVELOPMENT LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E. FIFTH STREET
GREENVILLE NC
27858-4353
US

IV. Provider business mailing address

1000 E. FIFTH STREET
GREENVILLE NC
27858-4353
US

V. Phone/Fax

Practice location:
  • Phone: 252-328-6926
  • Fax: 252-328-0649
Mailing address:
  • Phone: 252-328-6926
  • Fax: 252-328-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA CRANE MITCHELL
Title or Position: DIRECTOR
Credential: PHD
Phone: 252-737-2052