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General NPI Number Information
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NPI Number | 1104639905
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Entity Type | Organization
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Legal Business Name | ACHIEVE GA LLC
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1201 W PEACHTREE ST NW STE 2003
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City | ATLANTA
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State | GA
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Zip | 30309-3453
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Country | US
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Telephone | 732-886-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 126 MELVILLE AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4235
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Country | US
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Telephone | 732-886-8113
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | MALKA NUSSBAUM
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Credential | MS
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Telephone | 732-886-8113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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