Exchange Club Child Abuse Prevention Center of North Carolina

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EXCHANGE CLUB CHILD ABUSE PREVENTION CENTER OF NORTH CAROLINA

Practice address

500 W Northwest Blvd
Winston Salem, NC 27105-6526

Phone

(336) 748-9028

Fax

(336) 748-9030

NPI assigned

Oct 11, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Richard Paul Brodeur

Title

Operations Manager/Comptroller

Phone

(336) 748-9028

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Exchange SCAN Other name

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Melody Sherrell Archie

  • Clinical Social Worker
  • Winston Salem, NC
  • NPI 1982383121
  NPD (past)
• Arbra Cates

  • Clinical Social Worker
  • Winston Salem, NC
  • NPI 1740707751
  NPD (past)
• Shenae Mariyah Moncrief, LCSWA

  • Clinical Social Worker
  • Winston Salem, NC
  • NPI 1508548348
  NPD (past)
• Joetta A. Shepherd, MSW, LCSW

  • Clinical Social Worker
  • Winston Salem, NC
  • NPI 1760588057
  NPD (past)
• Ronnie Lee Wilkes Jr., LPC, CRC

  • Mental Health Counselor
  • Winston Salem, NC
  • NPI 1639326549
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417045741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W NORTHWEST BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271056526",
            "telephone_number": "336-748-9028",
            "fax_number": "336-748-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W NORTHWEST BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271056526",
            "telephone_number": "336-748-9028",
            "fax_number": "336-748-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCHANGE CLUB CHILD ABUSE PREVENTION CENTER OF NORTH CAROLINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRODEUR",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OPERATIONS MANAGER/COMPTROLLER",
        "authorized_official_telephone_number": "336-748-9028",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005439",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Exchange SCAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.