Healthcare Provider Details

I. General information

NPI: 1609530914
Provider Name (Legal Business Name): KIRKFIELD HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HEALTH PARK STE 201
RALEIGH NC
27615-4731
US

IV. Provider business mailing address

8300 HEALTH PARK STE 201
RALEIGH NC
27615-4731
US

V. Phone/Fax

Practice location:
  • Phone: 919-518-3151
  • Fax:
Mailing address:
  • Phone: 919-518-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA E DITTMER
Title or Position: OWNER
Credential: MD
Phone: 919-518-3151