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General NPI Number Information
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NPI Number | 1164585709
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Entity Type | Organization
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Legal Business Name | CHILDRENS TREATMENT CENTER INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 404 CEMETARY ROAD
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City | PINEBLUFF
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State | NC
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Zip | 28373
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Country | US
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Telephone | 910-281-3143
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Fax | 910-281-5933
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Provider Business Mailing Address
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Address Line | 404 CEMETARY RD.
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City | PINEBLUFF
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State | NC
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Zip | 28373
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Country | US
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Telephone | 910-281-3143
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Fax | 910-281-5933
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. BETTY A SMITH
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Credential |
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Telephone | 910-323-3771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-063-001
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License Number State | NC
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