Provider Demographics
NPI:1942637475
Name:GOLDEN, KYLA BRISTOL (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:BRISTOL
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:MARIE
Other - Last Name:BRISTOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:3919 NATIONAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1184
Mailing Address - Country:US
Mailing Address - Phone:301-476-8525
Mailing Address - Fax:
Practice Address - Street 1:3919 NATIONAL DR STE 200
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1184
Practice Address - Country:US
Practice Address - Phone:301-476-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5073101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor