Provider Demographics
NPI:1639896293
Name:STEVENS, KAYLA (LMSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:STEVENS
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 1:111 SPRINGHALL DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5351
Mailing Address - Country:US
Mailing Address - Phone:843-588-5710
Mailing Address - Fax:
Practice Address - Street 1:111 SPRINGHALL DR UNIT B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5351
Practice Address - Country:US
Practice Address - Phone:843-588-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC141971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical