Kenosha Archie-Wallace
Behavior Technician in Statesboro, GA. Individual provider (NPI-1).
NPI number1629902192
StatusActive
Last updated in NPPESJun 10, 2026
Details
- NPI
- 1629902192
- Entity type
- Individual (NPI-1)
- Name
- Kenosha Archie-Wallace
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 10, 2026
- Certification date
- Jun 10, 2026
- Last updated
- Jun 10, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
2760 Northside Dr WStatesboro, GA 30458-2159
Phone 912-208-2024
Mailing address
2805 S Industrial Hwy Ste 100Ann Arbor, MI 48104-6791
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All 92 Behavior Technician providers in Statesboro · All 1,371 providers in Statesboro
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