Provider Demographics
NPI:1992241335
Name:COMMUNITY ADVANCEMENT AGENCY LLC
Entity type:Organization
Organization Name:COMMUNITY ADVANCEMENT AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-594-4717
Mailing Address - Street 1:2020 REMOUNT RD STE W-107
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7476
Mailing Address - Country:US
Mailing Address - Phone:704-594-4717
Mailing Address - Fax:
Practice Address - Street 1:2020 REMOUNT RD STE W-107
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7476
Practice Address - Country:US
Practice Address - Phone:704-594-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health