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General NPI Number Information
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NPI Number | 1992534135
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Entity Type | Individual
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Provider Name | KAYLA MARIE VANCE LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 07/27/2024
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Last Update Date | 07/27/2024
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Provider Practice Location Address
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Address Line | 4814 SIX FORKS RD STE 202
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City | RALEIGH
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State | NC
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Zip | 27609-5246
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Country | US
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Telephone | 919-410-7858
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Fax |
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Provider Business Mailing Address
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Address Line | 10820 BROADVIEW DR APT 201
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City | RALEIGH
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State | NC
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Zip | 27617-8258
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Country | US
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Telephone | 984-296-1975
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A20335
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License Number State | NC
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