Provider Demographics
NPI:1689996332
Name:SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES
Entity Type:Organization
Organization Name:SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES
Other - Org Name:MCDOWELL CHILD ADVOCACY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-584-1105
Mailing Address - Street 1:PO BOX 3387
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-3387
Mailing Address - Country:US
Mailing Address - Phone:828-391-2803
Mailing Address - Fax:828-584-8910
Practice Address - Street 1:81 W FORT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752
Practice Address - Country:US
Practice Address - Phone:828-584-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty