Provider Demographics
NPI:1871746719
Name:ADLA, INC./OIC OF WAYNE COUNTY, CDC
Entity type:Organization
Organization Name:ADLA, INC./OIC OF WAYNE COUNTY, CDC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:QP, BS
Authorized Official - Phone:919-731-4876
Mailing Address - Street 1:P.O. BOX 963
Mailing Address - Street 2:
Mailing Address - City:MT. OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365
Mailing Address - Country:US
Mailing Address - Phone:919-731-2119
Mailing Address - Fax:919-739-4989
Practice Address - Street 1:612 S BREAZEALE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-2606
Practice Address - Country:US
Practice Address - Phone:919-731-2119
Practice Address - Fax:919-739-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare