Provider Demographics
NPI:1770990665
Name:REILLY, KAYLA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:COUGHLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:5329 OLEANDER DR STE 206
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5841
Mailing Address - Country:US
Mailing Address - Phone:910-535-1266
Mailing Address - Fax:910-679-6347
Practice Address - Street 1:5329 OLEANDER DR STE 206
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5841
Practice Address - Country:US
Practice Address - Phone:910-535-1266
Practice Address - Fax:910-679-6347
Is Sole Proprietor?:No
Enumeration Date:2014-07-13
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0102211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical