MEDICARE: RIA THERESA ARCHIBALD BCBA

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	1-19-39742	GA

General Provider Information

NPI Number	:	1801420898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIA THERESA ARCHIBALD BCBA

Provider Business Mailing Address
First Line	:	5829 CAMPBELLTON RD SW STE 104
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8036
Country	:	US
Telephone Number	:	770-940-0237
Fax Number	:	877-940-3221

Provider Business Practice Location Address
First Line	:	5829 CAMPBELLTON RD SW STE 104
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8036
Country	:	US
Telephone Number	:	770-940-0237
Fax Number	:	877-940-3221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	04/02/2025

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