Provider Demographics
NPI:1477339075
Name:WHITE, KAYLLA (DSOCSCI)
Entity type:Individual
Prefix:DR
First Name:KAYLLA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DSOCSCI
Other - Prefix:
Other - First Name:KAYLLA
Other - Middle Name:MARIE
Other - Last Name:BARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:951 MANORGREEN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2436
Mailing Address - Country:US
Mailing Address - Phone:443-952-1886
Mailing Address - Fax:
Practice Address - Street 1:9404 OWINGS HEIGHTS CIR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6350
Practice Address - Country:US
Practice Address - Phone:443-952-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TM1800X, 171M00000X, 225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor