Provider Demographics
NPI:1407422249
Name:KIND AUTHENTIC THERAPEUTIC INITIATIVES LLC
Entity Type:Organization
Organization Name:KIND AUTHENTIC THERAPEUTIC INITIATIVES LLC
Other - Org Name:KIND AUTHENTIC THERAPEUTIC INITIATIVES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:267-469-0050
Mailing Address - Street 1:1229 CHESTNUT ST STE 273
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4140
Mailing Address - Country:US
Mailing Address - Phone:267-975-2063
Mailing Address - Fax:
Practice Address - Street 1:2832 CORAL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4047
Practice Address - Country:US
Practice Address - Phone:267-469-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty