Provider Demographics
NPI:1811570740
Name:KAIROS COUNSELING, PLLC
Entity Type:Organization
Organization Name:KAIROS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ROUNDTREE
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-454-7154
Mailing Address - Street 1:6186 ROSEWAY CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-6509
Mailing Address - Country:US
Mailing Address - Phone:704-454-7154
Mailing Address - Fax:704-454-7154
Practice Address - Street 1:933 LOUISE AVE STE 101T
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2568
Practice Address - Country:US
Practice Address - Phone:704-726-8580
Practice Address - Fax:704-454-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty