Individual provider · Type 1 NPI

Kenosha Archie-Wallace

Behavior Technician · Statesboro, GA

NPI number 1629902192 Active

Practice location

2760 Northside Dr W
Statesboro, GA 30458-2159

Call (912) 208-2024 Map

Mailing address

2805 S Industrial Hwy Ste 100
Ann Arbor, MI 48104-6791

Specialties and licenses

TaxonomyCodeLicense
Behavior Technician Primary 106S00000XNone listed

Behavior Technician: The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That…

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About NPI 1629902192

Kenosha Archie-Wallace's National Provider Identifier is 1629902192, issued on Jun 10, 2026. The primary taxonomy on file is Behavior Technician (106S00000X), and the practice location is in Statesboro, GA. The record was last updated on Jun 10, 2026.