Healthcare Provider Details

I. General information

NPI: 1063030567
Provider Name (Legal Business Name): ZACARIA TERRY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4931 RIVERSIDE DR STE A
MACON GA
31210-1156
US

IV. Provider business mailing address

620 HALTON RD APT 2105
GREENVILLE SC
29607-3456
US

V. Phone/Fax

Practice location:
  • Phone: 800-701-0498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73020
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: