Provider Demographics
NPI:1174958144
Name:LIVINGSTON, KAYLA RENEE (MRC)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N RAMAGE ST
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-1359
Mailing Address - Country:US
Mailing Address - Phone:864-445-2968
Mailing Address - Fax:864-445-9592
Practice Address - Street 1:204 N RAMAGE ST
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-1359
Practice Address - Country:US
Practice Address - Phone:864-445-2968
Practice Address - Fax:864-445-9592
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD14SAMedicaid