Provider Demographics
NPI:1942806559
Name:POLING, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:POLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BELL ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3700
Mailing Address - Country:US
Mailing Address - Phone:304-637-8000
Mailing Address - Fax:304-636-4694
Practice Address - Street 1:100 BELL ST
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3700
Practice Address - Country:US
Practice Address - Phone:304-637-8000
Practice Address - Fax:304-636-4694
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSW122316943104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker