Healthcare Provider Details

I. General information

NPI: 1063309904
Provider Name (Legal Business Name): KAYLA MARIE CARR CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 BELMONT AVE
YOUNGSTOWN OH
44505-1450
US

IV. Provider business mailing address

3622 BELMONT AVE
YOUNGSTOWN OH
44505-1450
US

V. Phone/Fax

Practice location:
  • Phone: 234-719-1885
  • Fax:
Mailing address:
  • Phone: 234-719-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: