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General NPI Number Information
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NPI Number | 1366004848
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Entity Type | Organization
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Legal Business Name | VITALITY CLINICAL SERVICES, PLLC
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 300 E ARLINGTON BLVD OFC 9
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City | GREENVILLE
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State | NC
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Zip | 27858-5037
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Country | US
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Telephone | 252-220-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E ARLINGTON BLVD OFC 9
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City | GREENVILLE
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State | NC
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Zip | 27858-5037
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Country | US
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Telephone | 252-220-0288
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | KENDRICK BURDEN
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Credential | LCSW, LCAS
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Telephone | 252-717-3117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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