Provider Demographics
NPI:1053632026
Name:ALITTO, KELLY A (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:ALITTO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:833 HURRICANE SHOALS RD NE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4821
Mailing Address - Country:US
Mailing Address - Phone:833-628-8476
Mailing Address - Fax:770-200-1563
Practice Address - Street 1:6450 SPALDING DR STE B
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4650
Practice Address - Country:US
Practice Address - Phone:833-628-8476
Practice Address - Fax:770-200-1563
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
GA1-10-7611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst