Provider Demographics
NPI:1659046753
Name:RAILEY, KIRSTEN S (PHD, NCSP, BCBA)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:S
Last Name:RAILEY
Suffix:
Gender:F
Credentials:PHD, NCSP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 N DRUID HILLS RD APT G
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3720
Mailing Address - Country:US
Mailing Address - Phone:828-228-1176
Mailing Address - Fax:
Practice Address - Street 1:2964 PEACHTREE RD NW STE 324
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2120
Practice Address - Country:US
Practice Address - Phone:770-953-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 103TS0200X
GAPSY004511103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty