Healthcare Provider Details

I. General information

NPI: 1164268884
Provider Name (Legal Business Name): KAYLA FITCH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 KENNESAW AVE NW
MARIETTA GA
30060-6909
US

IV. Provider business mailing address

760 KENNESAW AVE NW
MARIETTA GA
30060-6909
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-0183
  • Fax:
Mailing address:
  • Phone: 770-427-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: