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General NPI Number Information
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NPI Number | 1770792699
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Entity Type | Organization
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Legal Business Name | LAKE CUMBERLAND CHILDREN'S ADVOCACY CENTER
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 427 SOUTH MAIN STREET
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City | JAMESTOWN
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State | KY
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Zip | 42629-0004
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Country | US
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Telephone | 270-343-6922
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Fax | 270-343-6006
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Provider Business Mailing Address
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Address Line | PO BOX 4
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City | JAMESTOWN
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State | KY
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Zip | 42629-0004
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Country | US
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Telephone | 270-343-6922
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Fax | 270-343-6006
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. PAMELA TRABISH EADS
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Credential | LCSW,BCD
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Telephone | 270-343-6922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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