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General NPI Number Information
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NPI Number | 1588846109
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Entity Type | Organization
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Legal Business Name | BURLINGTON PSYCHIATRY & ASSOC. INC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 1710 WESTBROOK AVE
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City | BURLINGTON
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State | NC
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Zip | 27215-8721
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Country | US
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Telephone | 336-228-7007
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Fax | 336-228-0097
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Provider Business Mailing Address
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Address Line | 1710 WESTBROOK AVE
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City | BURLINGTON
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State | NC
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Zip | 27215-8721
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Country | US
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Telephone | 336-228-7007
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Fax | 336-228-0097
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH JAY HEADEN
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Credential | MD
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Telephone | 336-228-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NC
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