Provider Demographics
NPI:1548975618
Name:KING, KAYLA BETHANY (MS, LCGC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:BETHANY
Last Name:KING
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 SHEFFEY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4929
Mailing Address - Country:US
Mailing Address - Phone:734-276-7883
Mailing Address - Fax:
Practice Address - Street 1:1101 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5008
Practice Address - Country:US
Practice Address - Phone:804-628-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0139000030170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS