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General NPI Number Information
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NPI Number | 1083435481
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Entity Type | Organization
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Legal Business Name | KINGDOM LOGISTICS GROUP, LLC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1548 ELLIE AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-8523
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Country | US
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Telephone | 910-391-6536
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Fax |
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Provider Business Mailing Address
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Address Line | 342 RAY AVE STE 6
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LARISSA HARRIS
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Credential |
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Telephone | 910-391-6536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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