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General NPI Number Information
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NPI Number | 1578722369
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Entity Type | Organization
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Legal Business Name | LINCOLN COUNTY CHILDREN'S ADVOCACY CENTER
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 122 NE 47TH ST
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City | NEWPORT
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State | OR
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Zip | 97365-1429
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Country | US
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Telephone | 541-574-0841
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Fax | 541-574-0821
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Provider Business Mailing Address
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Address Line | PO BOX 707
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City | NEWPORT
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State | OR
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Zip | 97365-0050
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Country | US
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Telephone | 541-574-0841
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Fax | 541-574-0821
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. THERESA WISNER
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Credential |
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Telephone | 541-574-0841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 1174640-8
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License Number State | OR
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