=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972347953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESURGENCE EDUCATIONAL SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2024
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 334 WOODMILL WAY SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30331-8036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-940-0237
-----------------------------------------------------
Fax | 877-940-3221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5829 CAMPBELLTON RD SW STE 104
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30331-8036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-940-0237
-----------------------------------------------------
Fax | 877-940-3221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DR. RIA THERESA ARCHIBALD
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 770-940-0237
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------