Provider Demographics
NPI:1366948580
Name:ASBURY, KAILA LEIGH (LCSW/LISW-CP)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:LEIGH
Last Name:ASBURY
Suffix:
Gender:F
Credentials:LCSW/LISW-CP
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:LEIGH
Other - Last Name:NORTHCUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6650 RIVERS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4809
Mailing Address - Country:US
Mailing Address - Phone:843-405-3161
Mailing Address - Fax:
Practice Address - Street 1:6650 RIVERS AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4809
Practice Address - Country:US
Practice Address - Phone:843-405-3161
Practice Address - Fax:843-897-1651
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171821041C0700X
COLCSW.099273121041C0700X, 1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker