Healthcare Provider Details

I. General information

NPI: 1255975090
Provider Name (Legal Business Name): KHADIJAH J. ARCHANGEL BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9306 PERKINS RD
BATON ROUGE LA
70810-1513
US

IV. Provider business mailing address

9306 PERKINS RD
BATON ROUGE LA
70810-1513
US

V. Phone/Fax

Practice location:
  • Phone: 225-257-9574
  • Fax: 225-377-4799
Mailing address:
  • Phone: 225-257-9574
  • Fax: 225-377-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90745
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: