Provider Demographics
NPI:1679773824
Name:THE EXCHANGE CLUBS CHILD ABUSE PREVENTION CENTER IN DURHAM, INC.
Entity type:Organization
Organization Name:THE EXCHANGE CLUBS CHILD ABUSE PREVENTION CENTER IN DURHAM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SANITBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-321-8636
Mailing Address - Street 1:3400 CROASDAILE DR.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705
Mailing Address - Country:US
Mailing Address - Phone:919-403-8249
Mailing Address - Fax:919-493-5725
Practice Address - Street 1:3400 CROASDAILE DR.
Practice Address - Street 2:SUITE 206
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-403-8249
Practice Address - Fax:919-493-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005760Medicaid