Provider Demographics
NPI:1548752124
Name:MONONGALIA COUNTY CHILD ADVOCACY CENTER, INC.
Entity Type:Organization
Organization Name:MONONGALIA COUNTY CHILD ADVOCACY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-598-0344
Mailing Address - Street 1:909 GREENBAG RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1504
Mailing Address - Country:US
Mailing Address - Phone:304-598-0344
Mailing Address - Fax:304-598-0558
Practice Address - Street 1:909 GREENBAG RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1504
Practice Address - Country:US
Practice Address - Phone:304-598-0344
Practice Address - Fax:304-598-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty