Provider Demographics
NPI:1114749587
Name:KIDSCARE PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:KIDSCARE PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGICAL ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:BATES
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPA, HSP-PA
Authorized Official - Phone:984-989-7520
Mailing Address - Street 1:11440 US 70 BUS HWY W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2208
Mailing Address - Country:US
Mailing Address - Phone:984-218-2995
Mailing Address - Fax:919-243-0035
Practice Address - Street 1:11440 US 70 BUS HWY W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2208
Practice Address - Country:US
Practice Address - Phone:984-218-2995
Practice Address - Fax:919-243-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty