Provider Demographics
NPI:1326162629
Name:GROWING PAINS, P.A.
Entity Type:Organization
Organization Name:GROWING PAINS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-270-3811
Mailing Address - Street 1:75 HAMPSTEAD VLG
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-8250
Mailing Address - Country:US
Mailing Address - Phone:910-270-3811
Mailing Address - Fax:910-270-3897
Practice Address - Street 1:75 HAMPSTEAD VLG
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8250
Practice Address - Country:US
Practice Address - Phone:910-270-3811
Practice Address - Fax:910-270-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC616101YM0800X
NC2467103TC2200X
NCC0032201041C0700X
NCC0039791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005143Medicaid
NC013F9OtherBCBS ORG.#
NC6005143Medicaid