Organization
IMPACT CHILD BEHAVIORAL SERVICES, INC.
Active
Other names
Kingdom Kids Impact Child Behavioral Services
Organization subpart
No
Provider details
NPI number
Authorized official
TANISHA DACOSTA (CEO)
(704) 773-8115
Entity
Organization
Contact information
Practice address
16325 NORTHCROSS DR STE A, HUNTERSVILLE, NC 28078-5044
(704) 773-8115
Mailing address
16325 NORTHCROSS DR STE A, HUNTERSVILLE, NC 28078-5044
(704) 773-8115
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/16/2025
Last updated
01/29/2025
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