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General NPI Number Information
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NPI Number | 1245448893
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Entity Type | Organization
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Legal Business Name | DAVIDSON CLERGY CENTER
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 455 S MAIN ST SUITE 200
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City | DAVIDSON
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State | NC
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Zip | 28036-8019
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Country | US
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Telephone | 704-895-6487
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Fax | 704-655-1481
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Provider Business Mailing Address
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Address Line | 455 S MAIN ST SUITE 200
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City | DAVIDSON
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State | NC
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Zip | 28036-8019
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Country | US
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Telephone | 704-895-6487
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Fax | 704-655-1481
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Authorized Official
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Title or Position | DIRECTOR
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Name | GEORGE WARREN JACOBS
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Credential | M.DIV.
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Telephone | 704-895-6487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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