Provider Demographics
NPI:1003593435
Name:STEPHENS, KAYLA ANN
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 RED COCKADED CT APT 302
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7173
Mailing Address - Country:US
Mailing Address - Phone:910-915-5074
Mailing Address - Fax:
Practice Address - Street 1:5535 CURRITUCK DR STE 220
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1155
Practice Address - Country:US
Practice Address - Phone:910-251-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2025-11-14
Deactivation Date:2025-10-28
Deactivation Code:
Reactivation Date:2025-11-14
Provider Licenses
StateLicense IDTaxonomies
NC1-25-83952103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst