Provider Demographics
NPI:1053725309
Name:MONONGALIA COUNTY CHILD ADVOCACY CENTER, INC.
Entity type:Organization
Organization Name:MONONGALIA COUNTY CHILD ADVOCACY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-598-0344
Mailing Address - Street 1:909 GREENBAG RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1504
Mailing Address - Country:US
Mailing Address - Phone:304-598-0344
Mailing Address - Fax:304-598-0558
Practice Address - Street 1:909 GREENBAG RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1504
Practice Address - Country:US
Practice Address - Phone:304-598-0344
Practice Address - Fax:304-598-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-15
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health