Provider Demographics
NPI:1790547925
Name:KIDS GARDEN
Entity Type:Organization
Organization Name:KIDS GARDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAVETRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-941-4207
Mailing Address - Street 1:1949 N SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7921
Mailing Address - Country:US
Mailing Address - Phone:704-941-4207
Mailing Address - Fax:
Practice Address - Street 1:1949 N SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7921
Practice Address - Country:US
Practice Address - Phone:704-526-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty