Provider Demographics
NPI:1669968715
Name:METZINGER, KAYLA MARIE (LCDC III)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MARIE
Last Name:METZINGER
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8261 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6254
Mailing Address - Country:US
Mailing Address - Phone:330-286-0050
Mailing Address - Fax:330-286-0055
Practice Address - Street 1:8261 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6254
Practice Address - Country:US
Practice Address - Phone:330-286-0050
Practice Address - Fax:330-286-0055
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHLCDCIII.161936101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH261QR0405XOtherCHEMICAL DEPENDENCY