Healthcare Provider Details

I. General information

NPI: 1871346189
Provider Name (Legal Business Name): KINFOLK NC ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MCDOWELL ST STE 125-2049
CHARLOTTE NC
28204-2623
US

IV. Provider business mailing address

301 S MCDOWELL ST STE 125-2049
CHARLOTTE NC
28204-2623
US

V. Phone/Fax

Practice location:
  • Phone: 980-249-4010
  • Fax: 980-249-4011
Mailing address:
  • Phone: 980-249-4010
  • Fax: 980-249-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ZISHE RUBIN
Title or Position: OWNER
Credential:
Phone: 917-246-8382