Impact Child Behavioral Services, Inc.

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

IMPACT CHILD BEHAVIORAL SERVICES, INC.

Doing business as

Kingdom Kids Impact Child Behavioral Services

Practice address

16325 Northcross Dr Ste a
Huntersville, NC 28078-5044

Phone

(704) 773-8115

NPI assigned

Jan 16, 2025

Last updated

Jan 29, 2025By 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

Tanisha Dacosta

Title

Ceo

Phone

(704) 773-8115

Specialties & licenses 1

Addresses

Other names 1

• Kingdom Kids Impact Child Behavioral Services Doing business as

Locations

Practitioners 2

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.

• Tanisha Marie Franklin-Dacosta

  • Behavior Technician
  • Concord, NC
  • NPI 1205679107
  NPD
• Leah Sampson, LCSW

  • Clinical Social Worker
  • Huntersville, NC
  • NPI 1427344894
  NPD

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

{
    "created_epoch": "1736985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1235940321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16325 NORTHCROSS DR STE A",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785044",
            "telephone_number": "704-773-8115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16325 NORTHCROSS DR STE A",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785044",
            "telephone_number": "704-773-8115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT CHILD BEHAVIORAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "DACOSTA",
        "authorized_official_first_name": "TANISHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-773-8115"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingdom Kids Impact Child Behavioral Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kingdom Kids Impact Child Behavioral Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Behavior Analyst in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Behavior Analyst in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.