Healthcare Provider Details

I. General information

NPI: 1164920724
Provider Name (Legal Business Name): KAYLA H SNAVLEY MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date: 10/05/2018
Reactivation Date: 10/14/2020

III. Provider practice location address

116 PIERCE AVE
MACON GA
31204-2891
US

IV. Provider business mailing address

305 FOXTAIL CHASE
KATHLEEN GA
31047-2923
US

V. Phone/Fax

Practice location:
  • Phone: 478-464-3015
  • Fax:
Mailing address:
  • Phone: 719-439-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC007520
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014252
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: