Provider Demographics
NPI:1578378246
Name:KHALILI, ORIYA
Entity type:Individual
Prefix:
First Name:ORIYA
Middle Name:
Last Name:KHALILI
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 1:1285 BREEZY LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3559
Mailing Address - Country:US
Mailing Address - Phone:404-513-8985
Mailing Address - Fax:
Practice Address - Street 1:1855 LAVISTA RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3819
Practice Address - Country:US
Practice Address - Phone:404-513-8985
Practice Address - Fax:678-244-6659
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-25-408873106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician