Healthcare Provider Details

I. General information

NPI: 1821907742
Provider Name (Legal Business Name): KENAN DAMOND DEVELOPMENT AND LEARNING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 APPIE RD
WALSTONBURG NC
27888-9591
US

IV. Provider business mailing address

PO BOX 159
WINTERVILLE NC
28590-0159
US

V. Phone/Fax

Practice location:
  • Phone: 252-414-4154
  • Fax:
Mailing address:
  • Phone: 252-414-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. NAKIRA S SMITH
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 252-414-4154