Provider Demographics
NPI:1538906144
Name:TEATIME WITH KHI, PLLC
Entity type:Organization
Organization Name:TEATIME WITH KHI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHIANA
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:WYATT-LOCUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-939-1110
Mailing Address - Street 1:722 CEDAR POINT BLVD # 227
Mailing Address - Street 2:
Mailing Address - City:CEDAR POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 PARROT LANDING DR
Practice Address - Street 2:
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-4654
Practice Address - Country:US
Practice Address - Phone:910-939-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty