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General NPI Number Information
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NPI Number | 1154631042
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Entity Type | Individual
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Provider Name | KYLIE CRAINE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 6264 HOSPITAL WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-1944
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Country | US
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Telephone | 678-977-8300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1916
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City | DOUGLASVILLE
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State | GA
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Zip | 30133-1916
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Country | US
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Telephone | 678-977-8300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY003413
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License Number State | GA
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