=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225316110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN'S ADVOCACY PROGRAMS OF THE BLUE RIDGE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2011
-----------------------------------------------------
Last Update Date | 08/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S MAIN ST
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24151-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-484-5566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 S MAIN ST
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24151-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-484-5566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE OFFICER
-----------------------------------------------------
Name | MRS. JOYCE CROUCH MORAN
-----------------------------------------------------
Credential | B.S.
-----------------------------------------------------
Telephone | 540-484-5566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------