Provider Demographics
NPI:1871800177
Name:DRAGONFLY HOUSE CHILDRENS ADVOCACY CENTER, INC.
Entity type:Organization
Organization Name:DRAGONFLY HOUSE CHILDRENS ADVOCACY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-753-6155
Mailing Address - Street 1:387 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028
Mailing Address - Country:US
Mailing Address - Phone:336-753-6155
Mailing Address - Fax:336-753-8868
Practice Address - Street 1:387 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028
Practice Address - Country:US
Practice Address - Phone:336-753-6155
Practice Address - Fax:336-753-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse PediatricsGroup - Single Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917088Medicaid