Provider Demographics
NPI:1598053399
Name:BURLINGTON PSYCHIATRY & ASSOC
Entity Type:Organization
Organization Name:BURLINGTON PSYCHIATRY & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-584-5255
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:336-584-5255
Mailing Address - Fax:336-584-5235
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:336-584-5255
Practice Address - Fax:336-584-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400266261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty