Provider Demographics
NPI:1891592853
Name:POWELL, KAIYA
Entity type:Individual
Prefix:
First Name:KAIYA
Middle Name:
Last Name:POWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 ADDISON PL
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9495
Mailing Address - Country:US
Mailing Address - Phone:912-755-0848
Mailing Address - Fax:
Practice Address - Street 1:806 TOWNE PARK DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9368
Practice Address - Country:US
Practice Address - Phone:912-755-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB1286992106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician