Provider Demographics
NPI:1497089742
Name:ECU CHILD DEVELOPMENT LABORATORY
Entity Type:Organization
Organization Name:ECU CHILD DEVELOPMENT LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CRANE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-737-2052
Mailing Address - Street 1:1000 E. FIFTH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4353
Mailing Address - Country:US
Mailing Address - Phone:252-328-6926
Mailing Address - Fax:252-328-0649
Practice Address - Street 1:1000 E. FIFTH STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4353
Practice Address - Country:US
Practice Address - Phone:252-328-6926
Practice Address - Fax:252-328-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency