Provider Demographics
NPI:1962776799
Name:CENTER FOR PREVENTION SERVICES
Entity type:Organization
Organization Name:CENTER FOR PREVENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBLE-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, CSAPC
Authorized Official - Phone:704-375-3784
Mailing Address - Street 1:1117 E MOREHEAD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2895
Mailing Address - Country:US
Mailing Address - Phone:704-375-3784
Mailing Address - Fax:704-333-3784
Practice Address - Street 1:1117 E MOREHEAD ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2895
Practice Address - Country:US
Practice Address - Phone:704-375-3784
Practice Address - Fax:704-333-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health