Provider Demographics
NPI:1215767132
Name:SOLANO, MYKAYLA
Entity type:Individual
Prefix:
First Name:MYKAYLA
Middle Name:
Last Name:SOLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 WESTBROOK AVE SW
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-5512
Mailing Address - Country:US
Mailing Address - Phone:704-712-8439
Mailing Address - Fax:
Practice Address - Street 1:7228 WESTBROOK AVE SW
Practice Address - Street 2:
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-5512
Practice Address - Country:US
Practice Address - Phone:704-712-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician