Provider Demographics
NPI:1851664924
Name:KIERTEKLES, RAYMOND S (PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:S
Last Name:KIERTEKLES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4989 PEACHTREE PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092
Mailing Address - Country:US
Mailing Address - Phone:678-969-3379
Mailing Address - Fax:770-248-0537
Practice Address - Street 1:4989 PEACHTREE PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:678-969-3379
Practice Address - Fax:770-248-0537
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00942016101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor