Healthcare Provider Details

I. General information

NPI: 1619754363
Provider Name (Legal Business Name): RHIANNA WALLACE BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 THORNBERRY DR
MADISONVILLE KY
42431-1672
US

IV. Provider business mailing address

PO BOX 931142
ATLANTA GA
31193-1142
US

V. Phone/Fax

Practice location:
  • Phone: 270-854-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2842820
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-295575
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: