MEDICARE: CLARKE ABA CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1790321768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARKE ABA CONSULTING LLC

Provider Business Mailing Address
First Line	:	3455 PEACHTREE RD NE FL 5
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3254
Country	:	US
Telephone Number	:	404-532-8271
Fax Number	:	404-689-0377

Provider Business Practice Location Address
First Line	:	3455 PEACHTREE RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3254
Country	:	US
Telephone Number	:	404-532-8271
Fax Number	:	404-689-0377

Authorized Official
Title or Position	:	BCBA
Name	:	RICKIESHA A MARCH
Credential	:	BCBA
Telephone Number	:	404-532-9271

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	09/22/2020

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