Basic Information
| Provider Information | |||||||||
| NPI: | 1932660248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSTON | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMFTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MERRY LN APT E | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603676349 | ||||||||
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| Practice Location | |||||||||
| Address1: | 231 COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523218080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 12150A | NC | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 2268 | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.