Provider Demographics
NPI:1730901737
Name:CERVANTES, KIARA GABRIELA
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:GABRIELA
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 MARIETTA BLVD NW APT 2372
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2069
Mailing Address - Country:US
Mailing Address - Phone:601-917-5220
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD MILTON PKWY STE C395
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3731
Practice Address - Country:US
Practice Address - Phone:678-384-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist