Healthcare Provider Details

I. General information

NPI: 1518633015
Provider Name (Legal Business Name): STARLESHA KIRKLAND RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 WHEELER RD STE 320
AUGUSTA GA
30909-6552
US

IV. Provider business mailing address

2171 FOSTER SPROUSE RD
THOMSON GA
30824-6918
US

V. Phone/Fax

Practice location:
  • Phone: 706-691-4729
  • Fax:
Mailing address:
  • Phone: 706-691-4729
  • Fax: 706-843-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number17514
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1625333
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: