Provider Demographics
NPI:1861299133
Name:OLMEDO, KAYLA MADISON (LCMHCA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MADISON
Last Name:OLMEDO
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BROOKSTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5206
Mailing Address - Country:US
Mailing Address - Phone:336-448-4948
Mailing Address - Fax:
Practice Address - Street 1:11 BROOKSTOWN AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5206
Practice Address - Country:US
Practice Address - Phone:336-448-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health