Provider Demographics
NPI:1245448893
Name:DAVIDSON CLERGY CENTER
Entity type:Organization
Organization Name:DAVIDSON CLERGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV
Authorized Official - Phone:704-895-6487
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8019
Mailing Address - Country:US
Mailing Address - Phone:704-895-6487
Mailing Address - Fax:704-655-1481
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8019
Practice Address - Country:US
Practice Address - Phone:704-895-6487
Practice Address - Fax:704-655-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health