Provider Demographics
NPI:1770792699
Name:LAKE CUMBERLAND CHILDREN'S ADVOCACY CENTER
Entity type:Organization
Organization Name:LAKE CUMBERLAND CHILDREN'S ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:TRABISH
Authorized Official - Last Name:EADS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,BCD
Authorized Official - Phone:270-343-6922
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42629-0004
Mailing Address - Country:US
Mailing Address - Phone:270-343-6922
Mailing Address - Fax:270-343-6006
Practice Address - Street 1:427 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:KY
Practice Address - Zip Code:42629-0004
Practice Address - Country:US
Practice Address - Phone:270-343-6922
Practice Address - Fax:270-343-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare