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General NPI Number Information
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NPI Number | 1326284910
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Entity Type | Organization
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Legal Business Name | KIDS CAN, LLC
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Dates
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Enumeration Date | 01/02/2009
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Last Update Date | 01/02/2009
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Provider Practice Location Address
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Address Line | 233 S SHARON AMITY RD SUITE 103
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City | CHARLOTTE
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State | NC
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Zip | 28211-2880
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Country | US
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Telephone | 704-364-4133
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Fax | 704-364-4134
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Provider Business Mailing Address
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Address Line | 233 S. SHARON-AMITY ROAD SUITE 103
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City | CHARLOTTE
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State | NC
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Zip | 28211-2880
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Country | US
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Telephone | 704-364-4133
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Fax | 704-364-4134
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Authorized Official
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Title or Position | PSYCHOLOGIST/MANAGER OF CORPORATION
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Name | DR. DAPHNE TIMMONS
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Credential | PH.D
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Telephone | 704-364-4133
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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 | 3216
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C001983
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1130
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License Number State | NC
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