Provider Demographics
NPI:1548734429
Name:GREENE, KAYLA ALEXANDRIA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ALEXANDRIA
Last Name:GREENE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 HENDERSON MILL RD APT T4
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-6019
Mailing Address - Country:US
Mailing Address - Phone:352-246-4640
Mailing Address - Fax:
Practice Address - Street 1:3105 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1015
Practice Address - Country:US
Practice Address - Phone:470-241-1353
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-18-33976103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst