Healthcare Provider Details

I. General information

NPI: 1659046753
Provider Name (Legal Business Name): KIRSTEN S RAILEY PHD, NCSP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 PEACHTREE RD NW STE 324
ATLANTA GA
30305-2120
US

IV. Provider business mailing address

3433 N DRUID HILLS RD APT G
DECATUR GA
30033-3720
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-4744
  • Fax:
Mailing address:
  • Phone: 828-228-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY004511
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: