Provider Demographics
NPI:1073169405
Name:WHITE, KAYLA BROOKE (MA LPC-R)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:BROOKE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N PIERCE ST APT 603
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3412
Mailing Address - Country:US
Mailing Address - Phone:757-653-1352
Mailing Address - Fax:
Practice Address - Street 1:950 N WASHINGTON ST STE 322
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1534
Practice Address - Country:US
Practice Address - Phone:757-653-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty