Provider Demographics
NPI:1801420898
Name:ARCHIBALD, RIA THERESA (BCBA)
Entity type:Individual
Prefix:
First Name:RIA
Middle Name:THERESA
Last Name:ARCHIBALD
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5829 CAMPBELLTON RD SW STE 104
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8036
Mailing Address - Country:US
Mailing Address - Phone:770-940-0237
Mailing Address - Fax:877-940-3221
Practice Address - Street 1:5829 CAMPBELLTON RD SW STE 104
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8036
Practice Address - Country:US
Practice Address - Phone:770-940-0237
Practice Address - Fax:877-940-3221
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-19-39742103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst