Provider Demographics
NPI:1518216829
Name:KAYANDA, OCTAVE M (PHT)
Entity Type:Individual
Prefix:DR
First Name:OCTAVE
Middle Name:M
Last Name:KAYANDA
Suffix:
Gender:M
Credentials:PHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3720
Mailing Address - Country:US
Mailing Address - Phone:336-358-6773
Mailing Address - Fax:
Practice Address - Street 1:2300 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3720
Practice Address - Country:US
Practice Address - Phone:336-358-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-1058251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health