Provider Demographics
NPI:1194390286
Name:KANG, RACHEL J (RBT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:J
Last Name:KANG
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3775 VENTURE DR BLDG M STE 101
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5217
Mailing Address - Country:US
Mailing Address - Phone:470-610-4222
Mailing Address - Fax:
Practice Address - Street 1:3775 VENTURE DR BLDG M STE 101
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5217
Practice Address - Country:US
Practice Address - Phone:470-610-4222
Practice Address - Fax:855-648-5902
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB563650106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician