Healthcare Provider Details

I. General information

NPI: 1386369924
Provider Name (Legal Business Name): KAYLA MCGUIRE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA MARIE MCGUIRE

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S MAIN ST
CHATHAM VA
24531-5436
US

IV. Provider business mailing address

705 MAIN ST
DANVILLE VA
24541-1803
US

V. Phone/Fax

Practice location:
  • Phone: 434-432-4443
  • Fax:
Mailing address:
  • Phone: 434-791-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013460
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: