Organization
COMMUNITY CONNECTIONS FAMILY LIFE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETONYA SHAW (DIRECTOE)
(336) 884-7179
Entity
Organization
Contact information
Practice address
622 N HAMILTON ST, SUITE 104, HIGH POINT, NC 27262-4076
(336) 884-7179
(336) 884-7189
Mailing address
622 N HAMILTON ST, SUITE 104, HIGH POINT, NC 27262-4076
(336) 884-7179
(336) 884-7189
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
8303323
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8303323
—
NC
Enumeration date
10/06/2011
Last updated
10/06/2011
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