Healthcare Provider Details

I. General information

NPI: 1750193025
Provider Name (Legal Business Name): KIARRA COPELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SOUTH TERRY STREET SUITE 100
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

113 SOUTH TERRY ST
LAWRENCEVILLE GA
30046
US

V. Phone/Fax

Practice location:
  • Phone: 404-500-7330
  • Fax:
Mailing address:
  • Phone: 404-500-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: