Provider Demographics
NPI:1619702933
Name:FRAZIER, KAYLA YVONNE (LCMHC-A)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:YVONNE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13953 CLAYBORN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-0089
Mailing Address - Country:US
Mailing Address - Phone:704-785-1216
Mailing Address - Fax:
Practice Address - Street 1:2315 E WT HARRIS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5133
Practice Address - Country:US
Practice Address - Phone:704-208-4458
Practice Address - Fax:866-309-6385
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional