Provider Demographics
NPI:1992260087
Name:DOUGLAS, KAYLA ANN (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 E WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2453
Mailing Address - Country:US
Mailing Address - Phone:724-654-9555
Mailing Address - Fax:724-498-0976
Practice Address - Street 1:143 E WALLACE AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2453
Practice Address - Country:US
Practice Address - Phone:724-654-9555
Practice Address - Fax:724-498-0976
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional