Provider Demographics
NPI:1467012013
Name:GAINES, KAYLA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 MONTCLAIR RD STE A
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2645
Mailing Address - Country:US
Mailing Address - Phone:205-775-0300
Mailing Address - Fax:205-618-9706
Practice Address - Street 1:1830 MONTCLAIR RD STE A
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2645
Practice Address - Country:US
Practice Address - Phone:205-775-0300
Practice Address - Fax:205-618-9706
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4621G101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)