Provider Demographics
NPI:1609029149
Name:KYLES, CAROL S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:S
Last Name:KYLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7076 WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:LUCAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27851-9452
Mailing Address - Country:US
Mailing Address - Phone:252-239-1352
Mailing Address - Fax:
Practice Address - Street 1:141 STORAGE RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8561
Practice Address - Country:US
Practice Address - Phone:252-443-0318
Practice Address - Fax:252-443-5079
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0056401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical