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Organization
COMMUNITY CONNECTIONS FAMILY LIFE CENTER LLC
Active
Organization
COMMUNITY CONNECTIONS FAMILY LIFE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETONYA SHAW (DIRECTOR)
(336) 253-1268
Entity
Organization
Contact information
Practice address
622 N HAMILTON ST, SUITE 104, HIGH POINT, NC 27262-4076
(336) 253-1268
Mailing address
PO BOX 47, HIGH POINT, NC 27261-0047
(336) 884-7179
(336) 884-7189
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
NC
133V00000X
Registered Dietitian
—
NC
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
252Y00000X
Early Intervention Provider Agency
—
NULL
Other
Enumeration date
10/26/2010
Last updated
03/04/2011
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