Provider Demographics
NPI:1043049059
Name:NC CENTER FOR AUTISTIC WOMEN AND GIRLS
Entity type:Organization
Organization Name:NC CENTER FOR AUTISTIC WOMEN AND GIRLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVALUATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GOLDBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-227-1325
Mailing Address - Street 1:6011 FAYETTEVILLE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6248
Mailing Address - Country:US
Mailing Address - Phone:919-228-8276
Mailing Address - Fax:
Practice Address - Street 1:6011 FAYETTEVILLE RD STE 106
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6248
Practice Address - Country:US
Practice Address - Phone:919-228-8276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities