Provider Demographics
NPI:1780829978
Name:GOOD KIDS THERAPEUTIC RESOURCES
Entity Type:Organization
Organization Name:GOOD KIDS THERAPEUTIC RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:WHITFIELD-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-491-3299
Mailing Address - Street 1:200 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2354
Mailing Address - Country:US
Mailing Address - Phone:919-491-3299
Mailing Address - Fax:
Practice Address - Street 1:200 WILSON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2354
Practice Address - Country:US
Practice Address - Phone:919-491-3299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health