Healthcare Provider Details

I. General information

NPI: 1245598945
Provider Name (Legal Business Name): CHILD ADVOCACY AND PARENTING PLACE EXCHANGE CLUB CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S 39TH ST
WILMINGTON NC
28403-6703
US

IV. Provider business mailing address

PO BOX 4305
WILMINGTON NC
28406-1305
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-1057
  • Fax: 910-791-2441
Mailing address:
  • Phone: 910-791-1057
  • Fax: 910-791-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MANDEL
Title or Position: CEO/CFO
Credential: MA
Phone: 910-791-1057