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General NPI Number Information
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NPI Number | 1285917534
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Entity Type | Organization
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Legal Business Name | EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF IREDELL COUN
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 207 WALNUT ST
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City | STATESVILLE
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State | NC
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Zip | 28677-5812
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Country | US
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Telephone | 704-878-2227
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Fax | 704-873-9672
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Provider Business Mailing Address
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Address Line | 207 WALNUT ST
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City | STATESVILLE
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State | NC
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Zip | 28677-5812
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Country | US
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Telephone | 704-878-2227
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Fax | 704-873-9672
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. AMY PERRAS EISELE
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Credential | LCSW
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Telephone | 704-878-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State | NC
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