Provider Demographics
NPI:1922790013
Name:O'BOYLE, KAYLA ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:O'BOYLE
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:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:WENTWORTH
Mailing Address - State:NC
Mailing Address - Zip Code:27375-0281
Mailing Address - Country:US
Mailing Address - Phone:336-427-9022
Mailing Address - Fax:336-427-9030
Practice Address - Street 1:2150 NC HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-9609
Practice Address - Country:US
Practice Address - Phone:336-427-9022
Practice Address - Fax:336-427-9030
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC015975104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker