MEDICARE: ALECIA KIDD MAMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC015374	GA
2	106H00000X	Marriage & Family Therapist	MFT001347	GA

General Provider Information

NPI Number	:	1790036317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALECIA KIDD MAMFT

Provider Business Mailing Address
First Line	:	1988 TOM BELL RD
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528
Country	:	US
Telephone Number	:	678-936-2090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1988 TOM BELL RD
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528
Country	:	US
Telephone Number	:	678-936-2090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2012
Last Update Date	:	01/02/2026

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