Provider Demographics
NPI:1043935828
Name:NEWSOM, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:MC ROBERTS
Mailing Address - State:KY
Mailing Address - Zip Code:41835-8954
Mailing Address - Country:US
Mailing Address - Phone:606-634-3909
Mailing Address - Fax:
Practice Address - Street 1:620 PARK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1922
Practice Address - Country:US
Practice Address - Phone:276-644-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional