Provider Demographics
NPI:1992298699
Name:DESTREE, KALA MYERS (KALA DESTREE, BCBA)
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:MYERS
Last Name:DESTREE
Suffix:
Gender:F
Credentials:KALA DESTREE, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 INGAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7919
Mailing Address - Country:US
Mailing Address - Phone:540-819-7035
Mailing Address - Fax:
Practice Address - Street 1:1320 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5713
Practice Address - Country:US
Practice Address - Phone:540-266-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst