=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578361770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAIROS THERAPEUTIC CARE, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2025
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 S NEW HOPE RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-480-1883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 S NEW HOPE RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-480-1883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOTHERAPIST
-----------------------------------------------------
Name | MRS. ALISON KEENE
-----------------------------------------------------
Credential | LCMHC
-----------------------------------------------------
Telephone | 502-316-4711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------