Provider Demographics
NPI:1710498985
Name:DAKOTA CHILDREN'S ADVOCACY CENTER
Entity Type:Organization
Organization Name:DAKOTA CHILDREN'S ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDOL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:701-202-7073
Mailing Address - Street 1:1303 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2066
Mailing Address - Country:US
Mailing Address - Phone:701-323-6864
Mailing Address - Fax:701-255-4495
Practice Address - Street 1:1303 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2066
Practice Address - Country:US
Practice Address - Phone:701-323-6864
Practice Address - Fax:701-255-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)