Provider Demographics
NPI:1790361749
Name:CARLYLE, KAYLA MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:CARLYLE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W SHORE DR APT A1
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7607
Mailing Address - Country:US
Mailing Address - Phone:740-503-5097
Mailing Address - Fax:
Practice Address - Street 1:4287 FIVE OAKS DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4214
Practice Address - Country:US
Practice Address - Phone:513-882-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011091781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical