Provider Demographics
NPI:1902523756
Name:PHILLIPS, KAYLA CATHERINE (MA)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:CATHERINE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2711 IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6605
Mailing Address - Country:US
Mailing Address - Phone:404-626-9260
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKE FORREST DR STE 450
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3837
Practice Address - Country:US
Practice Address - Phone:404-343-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health