Provider Demographics
NPI:1568668333
Name:BEHAVIORAL ENRICHMENT SERVICES, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL ENRICHMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLETTA
Authorized Official - Middle Name:LASHEA
Authorized Official - Last Name:HEADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-968-1864
Mailing Address - Street 1:6316 TIARA LN APT 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6316 TIARA LN APT 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8407
Practice Address - Country:US
Practice Address - Phone:704-968-1864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1915991251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301649Medicaid