Provider Demographics
NPI:1972260743
Name:KALEIDOSCOPE CARES THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:KALEIDOSCOPE CARES THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:919-792-8831
Mailing Address - Street 1:312 W MILLBROOK RD STE 121
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4398
Mailing Address - Country:US
Mailing Address - Phone:919-792-8831
Mailing Address - Fax:
Practice Address - Street 1:312 W MILLBROOK RD STE 121
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4398
Practice Address - Country:US
Practice Address - Phone:919-792-8831
Practice Address - Fax:919-238-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093225159Medicaid