| Kids Central Of The Carolinas, Llc | |
|
4722 Park Rd Charlotte NC 28209 | |
| (704) 369-2502 | |
| (704) 688-2961 |
| Full Name | Kids Central Of The Carolinas, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4722 Park Rd, Charlotte, North Carolina |
| Authorized Official Name and Position | Kamilah Mcphail Mckissick (CLINICAL DIRECTOR / LICENSED PSYCOL) |
| Authorized Official Contact | 9802144281 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kids Central Of The Carolinas, Llc 617 N. Summit Ave Charlotte NC 28216 Ph: (704) 369-2502 | Kids Central Of The Carolinas, Llc 4722 Park Rd Charlotte NC 28209 Ph: (704) 369-2502 |
| NPI Number | 1952406845 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 11/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952406845 | NPI | - | NPPES |
| 016N5 | Other | NC | BCBSNC |
| 6005230 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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