Kids Central of the Carolinas, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

KIDS CENTRAL OF THE CAROLINAS, LLC

Practice address

4722 Park Rd
Charlotte, NC 28209

Phone

(704) 369-2502

Fax

(704) 688-2961

NPI assigned

Sep 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kamilah McPhail McKissick, PSY. D.

Title

Clinical Director / Licensed Psycol

Phone

(980) 214-4281

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Elon Homes and Schools for Children2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Elon Homes and Schools for Children

  • Psychologist
  • Charlotte, NC
  • NPI 1114362423
  NPD tax ID

Locations

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479168000000",
    "number": "1952406845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 N. SUMMIT AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28216",
            "telephone_number": "704-369-2502",
            "fax_number": "704-688-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4722 PARK RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28209",
            "telephone_number": "704-369-2502",
            "fax_number": "704-688-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS CENTRAL OF THE CAROLINAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2016-11-15",
        "status": "A",
        "authorized_official_last_name": "MCKISSICK",
        "authorized_official_first_name": "KAMILAH",
        "authorized_official_middle_name": "MCPHAIL",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR / LICENSED PSYCOL",
        "authorized_official_telephone_number": "980-214-4281",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY. D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "016N5",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005230",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Christopher Kibler, D.D.S.
• Kibun Health NC PLLC
• Katie Kickertz, DDS, MS
• Leslie Mize Kidd, OTL
• Kids Can, LLC
• Kids Club ABA NC
• Kids First Pediatrics
• Kids First Pediatrics, PA
• Kids First Therapy North Carolina LLC
• Kids Garden

• Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; 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.