Organization
KIDS CENTRAL OF THE CAROLINAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMILAH MCPHAIL MCKISSICK PSY. D. (CLINICAL DIRECTOR / LICENSED PSYCOL)
(980) 214-4281
Entity
Organization
Contact information
Practice address
4722 PARK RD, CHARLOTTE, NC 28209
(704) 369-2502
(704) 688-2961
Mailing address
617 N. SUMMIT AVE, CHARLOTTE, NC 28216
(704) 369-2502
(704) 688-2961
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016N5
BCBSNC
NC
05
—
6005230
—
NC
Enumeration date
09/14/2006
Last updated
11/15/2016
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