Provider Demographics
NPI:1548099328
Name:BORGOLINI, KAYLA (LCSWA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BORGOLINI
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MICHELLE
Other - Last Name:BORGOLINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWA
Mailing Address - Street 1:210 ALBATROSS ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6702
Mailing Address - Country:US
Mailing Address - Phone:757-749-3487
Mailing Address - Fax:
Practice Address - Street 1:407 S GRIFFIN ST STE J
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4693
Practice Address - Country:US
Practice Address - Phone:252-331-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0209071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical