Organization · NPI-2

Prestige Childrens Trauma Child Development Corp

Behavior Analyst · Concord, NC

NPI number1427764836
StatusActive
Last updated in NPPESApr 25, 2023

Details

NPI
1427764836
Entity type
Organization (NPI-2)
Legal business name
Prestige Childrens Trauma Child Development Corp
Organization subpart
No
Enumeration date
Jan 30, 2023
Certification date
Apr 25, 2023
Last updated
Apr 25, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103K00000X Behavior Analyst––Yes
101YP1600X Counselor, Pastoral––
315P00000X Intermediate Care Facility, Intellectual Disabilities––
106S00000X Behavior Technician––
251S00000X Community/Behavioral Health––
252Y00000X Early Intervention Provider Agency––
305S00000X Point of Service––

Other names

  • Prestige Childrens Trauma Cdc (Doing Business As)

Practice location

3030 Glen Laurel Dr
Concord, NC 28025-1614

Phone 980-219-0907

Mailing address

57 Union St S Ste 1221
Concord, NC 28025-5009

Phone 980-292-2204

Authorized official

Wanda Marie Burns
Pastoral Counselor
8887791232

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