Provider Demographics
NPI:1639427891
Name:GAINES, KARYLA (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KARYLA
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:KARYLA
Other - Middle Name:
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DIPL AC
Mailing Address - Street 1:1279 OLD IVY WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7994
Mailing Address - Country:US
Mailing Address - Phone:843-881-3002
Mailing Address - Fax:
Practice Address - Street 1:1279 OLD IVY WAY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7994
Practice Address - Country:US
Practice Address - Phone:843-881-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC25171100000X
NY001477171100000X
SC2088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171100000XOther Service ProvidersAcupuncturist