Healthcare Provider Details

I. General information

NPI: 1124949417
Provider Name (Legal Business Name): KCN BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 VINELAND AVE
BRIDGETON NJ
08302-4823
US

IV. Provider business mailing address

899 VINELAND AVE
BRIDGETON NJ
08302-4823
US

V. Phone/Fax

Practice location:
  • Phone: 856-301-5432
  • Fax:
Mailing address:
  • Phone: 856-301-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY ANN CARTER-NICHOLS
Title or Position: CEO/FOUNDER
Credential: DHA
Phone: 856-301-5432