Provider Demographics
NPI:1346781747
Name:COMMUNITY VIOLENCE INTERVENTION CENTER
Entity Type:Organization
Organization Name:COMMUNITY VIOLENCE INTERVENTION CENTER
Other - Org Name:CVIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL-JIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-746-0405
Mailing Address - Street 1:211 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4737
Mailing Address - Country:US
Mailing Address - Phone:701-746-0405
Mailing Address - Fax:701-746-5918
Practice Address - Street 1:211 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4737
Practice Address - Country:US
Practice Address - Phone:701-746-0405
Practice Address - Fax:701-746-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)