Healthcare Provider Details

I. General information

NPI: 1023604725
Provider Name (Legal Business Name): SPILL THE TEA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2387 PROFESSIONAL HEIGHTS DR STE 10
LEXINGTON KY
40503-3004
US

IV. Provider business mailing address

2387 PROFESSIONAL HEIGHTS DR STE 10
LEXINGTON KY
40503-3004
US

V. Phone/Fax

Practice location:
  • Phone: 859-629-9865
  • Fax:
Mailing address:
  • Phone: 859-629-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAWANDA E MCCANTS
Title or Position: OWNER
Credential: LPCC
Phone: 859-629-9865