Healthcare Provider Details

I. General information

NPI: 1700705548
Provider Name (Legal Business Name): ALEXANDRIA PAIGE KIELTYKA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 MCGINNIS FERRY RD STE 1304
ALPHARETTA GA
30005-3951
US

IV. Provider business mailing address

4080 MCGINNIS FERRY RD STE 1304
ALPHARETTA GA
30005-3951
US

V. Phone/Fax

Practice location:
  • Phone: 678-740-3990
  • Fax: 844-903-4670
Mailing address:
  • Phone: 678-740-3990
  • Fax: 844-903-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC011265
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: