Provider Demographics
NPI:1255909594
Name:BULLARD, KAYLA GENTRY (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:GENTRY
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:THURMOND
Mailing Address - State:NC
Mailing Address - Zip Code:28683-9439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:714 CAROLINA AVE STE A
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7793
Practice Address - Country:US
Practice Address - Phone:336-818-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0162961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical