Healthcare Provider Details

I. General information

NPI: 1356989792
Provider Name (Legal Business Name): FAMILY AND CHILD ABUSE PREVENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CHERRY ST
TOLEDO OH
43608-2667
US

IV. Provider business mailing address

2460 CHERRY ST
TOLEDO OH
43608-2667
US

V. Phone/Fax

Practice location:
  • Phone: 419-244-3053
  • Fax: 419-244-1100
Mailing address:
  • Phone: 419-244-3053
  • Fax: 419-244-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIE D JENKINS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LPCC S, NCC, PH.D
Phone: 419-244-3053