Provider Demographics
NPI:1669341772
Name:BOYS AND GIRLS CLUBS OF CENTRAL CAROLINA
Entity type:Organization
Organization Name:BOYS AND GIRLS CLUBS OF CENTRAL CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:FALLON
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, CPTD
Authorized Official - Phone:919-825-0101
Mailing Address - Street 1:1414 BRAGG ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5435
Mailing Address - Country:US
Mailing Address - Phone:919-825-0101
Mailing Address - Fax:
Practice Address - Street 1:1414 BRAGG ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5435
Practice Address - Country:US
Practice Address - Phone:919-825-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:O. T. SLOAN BOYS AND GIRLS CLUB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty