Provider Demographics
NPI:1285917534
Name:EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF IREDELL COUN
Entity type:Organization
Organization Name:EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF IREDELL COUN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:PERRAS
Authorized Official - Last Name:EISELE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-878-2227
Mailing Address - Street 1:207 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5812
Mailing Address - Country:US
Mailing Address - Phone:704-878-2227
Mailing Address - Fax:704-873-9672
Practice Address - Street 1:207 WALNUT ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5812
Practice Address - Country:US
Practice Address - Phone:704-878-2227
Practice Address - Fax:704-873-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable