Healthcare Provider Details

I. General information

NPI: 1710671623
Provider Name (Legal Business Name): KAYLA M BEARD BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 OLEANDER DR STE 100
WILMINGTON NC
28403-4723
US

IV. Provider business mailing address

607 DAVID ST
ELIZABETHTOWN NC
28337-8815
US

V. Phone/Fax

Practice location:
  • Phone: 910-239-0377
  • Fax:
Mailing address:
  • Phone: 910-247-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27485
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: