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General NPI Number Information
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NPI Number | 1730426719
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Entity Type | Organization
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Legal Business Name | CHILD ADVOCACY CENTER
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 3830 EVANS AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-9305
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Country | US
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Telephone | 239-939-4794
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Fax |
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Provider Business Mailing Address
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Address Line | 3830 EVANS AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-9305
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Country | US
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Telephone | 239-939-4794
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Fax |
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Authorized Official
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Title or Position | FA DIRECTOR
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Name | VAL GILL
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Credential | M.A.
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Telephone | 239-939-2808
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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 | FL
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