Provider Demographics
NPI:1912649351
Name:WYATT-LOCUS, KHIANA GRAY (LCSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:KHIANA
Middle Name:GRAY
Last Name:WYATT-LOCUS
Suffix:
Gender:
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:KHIANA
Other - Middle Name:GRAY
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7151 OKELLY CHAPEL RD # 326
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6849
Mailing Address - Country:US
Mailing Address - Phone:910-939-1110
Mailing Address - Fax:
Practice Address - Street 1:7151 OKELLY CHAPEL RD # 326
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6849
Practice Address - Country:US
Practice Address - Phone:910-939-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0172891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical