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General NPI Number Information
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NPI Number | 1588436455
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Entity Type | Individual
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Provider Name | KAYLA CARUSO LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 6614 SHALLOWFORD RD STE 250
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City | LEWISVILLE
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State | NC
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Zip | 27023-9305
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Country | US
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Telephone | 336-945-0137
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Fax |
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Provider Business Mailing Address
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Address Line | 2740 BRIDGEPORT DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5447
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Country | US
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Telephone | 385-236-6073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A19340
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License Number State | NC
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