Healthcare Provider Details

I. General information

NPI: 1023971504
Provider Name (Legal Business Name): KAILA MARIE KRAUSE CADC, ICADC, QP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COPPERFIELD BLVD NE
CONCORD NC
28025-2428
US

IV. Provider business mailing address

223 E LINE DR
BELMONT NC
28012-3287
US

V. Phone/Fax

Practice location:
  • Phone: 704-782-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number831565
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-28677
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: