Healthcare Provider Details

I. General information

NPI: 1093622698
Provider Name (Legal Business Name): KAYLA LANAE GRABLOW MA, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E LANDIS AVE
VINELAND NJ
08360-4111
US

IV. Provider business mailing address

1514 KINGS HWY
SWEDESBORO NJ
08085-1212
US

V. Phone/Fax

Practice location:
  • Phone: 800-845-0336
  • Fax:
Mailing address:
  • Phone: 800-845-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00992900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: