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General NPI Number Information
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NPI Number | 1659046753
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Entity Type | Individual
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Provider Name | KIRSTEN S RAILEY PHD, NCSP, BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 2964 PEACHTREE RD NW STE 324
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City | ATLANTA
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State | GA
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Zip | 30305-2120
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Country | US
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Telephone | 770-953-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 3433 N DRUID HILLS RD APT G
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City | DECATUR
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State | GA
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Zip | 30033-3720
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Country | US
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Telephone | 828-228-1176
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY004511
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License Number State | GA
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