Provider Demographics
NPI:1518280148
Name:CHILDREN AND FAMILY COMMUNITY DEVELOPMENT
Entity Type:Organization
Organization Name:CHILDREN AND FAMILY COMMUNITY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-943-9106
Mailing Address - Street 1:POST OFFICE BOX 1116
Mailing Address - Street 2:700 EAST MAIN ST.
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543
Mailing Address - Country:US
Mailing Address - Phone:919-943-9106
Mailing Address - Fax:
Practice Address - Street 1:2623 N. MAIN ST.
Practice Address - Street 2:CHILDREN & FAMILY COMMUNITY DEVELOPMENT
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540
Practice Address - Country:US
Practice Address - Phone:919-943-9106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1182-05-001252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency