Provider Demographics
NPI:1952060121
Name:IVORY, KAYLA ELIZABETH (APC, MS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELIZABETH
Last Name:IVORY
Suffix:
Gender:F
Credentials:APC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 TERRANE RDG
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CTY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4015
Mailing Address - Country:US
Mailing Address - Phone:678-457-0108
Mailing Address - Fax:
Practice Address - Street 1:205 BRANDYWINE BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7651
Practice Address - Country:US
Practice Address - Phone:404-539-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GAAPC009380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program