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General NPI Number Information
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NPI Number | 1932902400
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Entity Type | Organization
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Legal Business Name | RISE ABA THERAPY
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 845 N 20TH ST
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1024
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Country | US
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Telephone | 843-592-8582
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Fax |
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Provider Business Mailing Address
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Address Line | 157 RIVER WINDING RD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-9394
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Country | US
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Telephone | 843-592-8582
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEANNA D KYLE
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Credential | ME D, BCBA, LBA
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Telephone | 843-592-8582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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