Healthcare Provider Details

I. General information

NPI: 1578491064
Provider Name (Legal Business Name): KYRA PRASHAW BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S COLLEGE ST
CEDARTOWN GA
30125-3406
US

IV. Provider business mailing address

325 PRIOR ST W
CEDARTOWN GA
30125-2907
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-3475
  • Fax: 678-550-9396
Mailing address:
  • Phone: 770-339-3475
  • Fax: 678-550-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17147
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: