Healthcare Provider Details

I. General information

NPI: 1063346336
Provider Name (Legal Business Name): KAYLA MARIE GOIN QMHP-T, CSAC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 MEADOWVIEW DR STE 5&6
DANVILLE VA
24541-7351
US

IV. Provider business mailing address

785 APPLEWOOD RD
MARTINSVILLE VA
24112-7475
US

V. Phone/Fax

Practice location:
  • Phone: 877-848-9810
  • Fax:
Mailing address:
  • Phone: 276-224-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: