Provider Demographics
NPI:1679619571
Name:CHILD DEVELOPMENT CENTER, INC.
Entity Type:Organization
Organization Name:CHILD DEVELOPMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN
Authorized Official - Phone:910-343-4245
Mailing Address - Street 1:3802 PRINCESS PLACE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3226
Mailing Address - Country:US
Mailing Address - Phone:910-343-4245
Mailing Address - Fax:910-343-4254
Practice Address - Street 1:3802 PRINCESS PLACE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3226
Practice Address - Country:US
Practice Address - Phone:910-343-4245
Practice Address - Fax:910-343-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8300128B101YS0200X
NC7270225100000X
NC9077225100000X
NC3496225X00000X
NC1237225X00000X
NC6530235Z00000X
NC4584235Z00000X
NC6881235Z00000X
NCP003592251B00000X
NC65000539251C00000X
NCP003800251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300128BMedicaid
NC8300128KMedicaid
NC7211807Medicaid