Provider Demographics
NPI:1588846109
Name:BURLINGTON PSYCHIATRY & ASSOC. INC
Entity Type:Organization
Organization Name:BURLINGTON PSYCHIATRY & ASSOC. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HEADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-228-7007
Mailing Address - Street 1:1710 WESTBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8721
Mailing Address - Country:US
Mailing Address - Phone:336-228-7007
Mailing Address - Fax:336-228-0097
Practice Address - Street 1:1710 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8721
Practice Address - Country:US
Practice Address - Phone:336-228-7007
Practice Address - Fax:336-228-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty