Provider Demographics
NPI:1588128060
Name:VINES, KYLA HOLLY (MS, LPC)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:HOLLY
Last Name:VINES
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 COUNTY ROAD 3949
Mailing Address - Street 2:
Mailing Address - City:ARLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35541-2649
Mailing Address - Country:US
Mailing Address - Phone:256-708-5118
Mailing Address - Fax:
Practice Address - Street 1:1173 HELICON RD
Practice Address - Street 2:
Practice Address - City:ARLEY
Practice Address - State:AL
Practice Address - Zip Code:35541-2011
Practice Address - Country:US
Practice Address - Phone:256-708-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health