Provider Demographics
NPI:1275058372
Name:AUSTIN, KIRA MARIE (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:MARIE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:MARIE
Other - Last Name:GOTTBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11510 ROLLING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-2031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5408 CHAMBERLAYNE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2407
Practice Address - Country:US
Practice Address - Phone:855-444-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-18509103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst