Provider Demographics
NPI:1578722369
Name:LINCOLN COUNTY CHILDREN'S ADVOCACY CENTER
Entity Type:Organization
Organization Name:LINCOLN COUNTY CHILDREN'S ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-574-0841
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-0050
Mailing Address - Country:US
Mailing Address - Phone:541-574-0841
Mailing Address - Fax:541-574-0821
Practice Address - Street 1:122 NE 47TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-1429
Practice Address - Country:US
Practice Address - Phone:541-574-0841
Practice Address - Fax:541-574-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1174640-8261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health