Provider Demographics
NPI:1154628469
Name:KEHLE, LARA KOWALSKY (MS, BCABA, LPA)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:KOWALSKY
Last Name:KEHLE
Suffix:
Gender:F
Credentials:MS, BCABA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 LAUGHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5267
Mailing Address - Country:US
Mailing Address - Phone:919-386-5514
Mailing Address - Fax:
Practice Address - Street 1:1424 LAUGHRIDGE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5267
Practice Address - Country:US
Practice Address - Phone:919-386-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4086103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool