Healthcare Provider Details

I. General information

NPI: 1457034563
Provider Name (Legal Business Name): KAILA NICOLE LAXA LPC, PHD, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S INDEPENDENCE BLVD STE 200
VIRGINIA BEACH VA
23452-1178
US

IV. Provider business mailing address

3012 PARKSIDE CIR
SUFFOLK VA
23435-3378
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-6463
  • Fax:
Mailing address:
  • Phone: 757-383-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015179
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: