Provider Demographics
NPI:1346601978
Name:KIDS ON UP PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:KIDS ON UP PSYCHOTHERAPY, INC.
Other - Org Name:SOLOMON KOBES, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-240-5548
Mailing Address - Street 1:205 DELLA ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6050
Mailing Address - Country:US
Mailing Address - Phone:919-240-5548
Mailing Address - Fax:919-443-1199
Practice Address - Street 1:101 CONNER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7038
Practice Address - Country:US
Practice Address - Phone:919-240-5548
Practice Address - Fax:919-443-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2852251OtherMEDICARE PTAN
NC6106445Medicaid