Provider Demographics
NPI:1043063464
Name:THE KAIROS EXPERIENCE, PLLC
Entity type:Organization
Organization Name:THE KAIROS EXPERIENCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DESHALA
Authorized Official - Middle Name:CHANCHEZ
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-337-2164
Mailing Address - Street 1:1208 OAKCREST GREEN CT
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6924
Mailing Address - Country:US
Mailing Address - Phone:919-337-2164
Mailing Address - Fax:919-650-1259
Practice Address - Street 1:1208 OAKCREST GREEN CT
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6924
Practice Address - Country:US
Practice Address - Phone:919-337-2164
Practice Address - Fax:919-650-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518632843OtherBCBS, AETNA, OPTUM, OSCAR, AND OTHER PRIVATE INSURANCE