Provider Demographics
NPI:1811684194
Name:ALVAREZ, KAIA
Entity type:Individual
Prefix:
First Name:KAIA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAIA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4536 WASHINGTON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5901
Mailing Address - Country:US
Mailing Address - Phone:706-489-1550
Mailing Address - Fax:706-535-3596
Practice Address - Street 1:4536 WASHINGTON RD STE 2
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5901
Practice Address - Country:US
Practice Address - Phone:706-489-1550
Practice Address - Fax:706-535-3596
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-262287106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician