Provider Demographics
NPI:1457921033
Name:EZA, KAYLA ROSE (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ROSE
Last Name:EZA
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:ROSE
Other - Last Name:MULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWA
Mailing Address - Street 1:4311 OLD OCEAN HWY
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8637
Mailing Address - Country:US
Mailing Address - Phone:877-935-5255
Mailing Address - Fax:
Practice Address - Street 1:4311 OLD OCEAN HWY
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8637
Practice Address - Country:US
Practice Address - Phone:877-935-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0164171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty