Provider Demographics
NPI:1649602533
Name:RAULERSON-KELLAS, KATHRYN ELIZABETH (BCABA, LABA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:RAULERSON-KELLAS
Suffix:
Gender:F
Credentials:BCABA, LABA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:JABLONSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12727 MCMANUS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4459
Mailing Address - Country:US
Mailing Address - Phone:757-877-2300
Mailing Address - Fax:757-846-6959
Practice Address - Street 1:12727 MCMANUS BLVD STE G
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4459
Practice Address - Country:US
Practice Address - Phone:757-869-4162
Practice Address - Fax:757-846-6959
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000030106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0134000030OtherVIRGINIA BOARD OF MEDICINE