Provider Demographics
NPI:1114362423
Name:ELON HOMES AND SCHOOLS FOR CHILDREN
Entity Type:Organization
Organization Name:ELON HOMES AND SCHOOLS FOR CHILDREN
Other - Org Name:KIDS CENTRAL OF THE CAROLINAS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMILAH
Authorized Official - Middle Name:MCPHAIL
Authorized Official - Last Name:MCKISSICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-369-2502
Mailing Address - Street 1:1717 SHARON RD W
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5663
Mailing Address - Country:US
Mailing Address - Phone:704-369-2502
Mailing Address - Fax:
Practice Address - Street 1:3801 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3215
Practice Address - Country:US
Practice Address - Phone:704-716-6521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty