Carolina Community Consultants, PLLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

CAROLINA COMMUNITY CONSULTANTS, PLLC

Doing business as

Kenneth J. Headen, MD

Practice address

2627 Grimsley St
Greensboro, NC 27403-3135

Phone

(335) 437-2354

Fax

(336) 279-1226

NPI assigned

Mar 16, 2021

Organization subpart

No

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

Authorized official

Name

Prof. Imani Arthur, MSW, MPA

Title

Coo

Phone

(919) 824-1299

Specialties & licenses 1

Addresses

Other names 1

• Kenneth J. Headen, MD Doing business as

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1902481443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4992 WINDING RIDGE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274063158",
            "telephone_number": "919-824-1299",
            "fax_number": "844-984-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 GRIMSLEY ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274033135",
            "telephone_number": "335-437-2354",
            "fax_number": "336-279-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA COMMUNITY CONSULTANTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "ARTHUR",
        "authorized_official_first_name": "IMANI",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "919-824-1299",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "MSW, MPA"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenneth J. Headen, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carolina Care, LLC
• Carolina Child Psychiatric Services, PA
• Carolina Children'S Eye Care, PA
• Carolina Chiropractic Center P a
• Carolina Community Behavioral Services LLC
• Carolina Dermatology Center
• Carolina Diagnostic Corporation
• Carolina Diagnostics, Inc
• Carolina Eye Associates Inc
• Carolina Eye Surgical and Laser Center

• Psychiatry Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.