Provider Demographics
NPI:1992534135
Name:VANCE, KAYLA MARIE (LCMHCA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:VANCE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 BROADVIEW DR APT 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8258
Mailing Address - Country:US
Mailing Address - Phone:984-296-1975
Mailing Address - Fax:
Practice Address - Street 1:4814 SIX FORKS RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5246
Practice Address - Country:US
Practice Address - Phone:919-410-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional