Healthcare Provider Details

I. General information

NPI: 1316346356
Provider Name (Legal Business Name): KYLIE MARSALA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 POWELL RD
AUGUSTA GA
30909-9529
US

IV. Provider business mailing address

1780 POWELL RD
AUGUSTA GA
30909-9529
US

V. Phone/Fax

Practice location:
  • Phone: 431-889-8477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010314
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: