KENOSHA ARCHIE-WALLACE
NPI 1629902192
Behavior Technician in Statesboro, GA

Active since June 10, 2026
2760 NORTHSIDE DR W, STATESBORO, GA 30458(912) 208-2024 Get Directions Write a Review

NPPES record last updated: June 10, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Kenosha Archie-wallace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENOSHA ARCHIE-WALLACE (NPI 1629902192) is an individual behavior technician in Statesboro, Georgia and active in the NPI registry since June 2026.

NPPES Registry Identity

NPI1629902192
Entity TypeIndividualFemale
Primary Taxonomy106S00000X
Provider Legal NameKENOSHA ARCHIE-WALLACE
Location Address2760 NORTHSIDE DR WStatesboro, GA 30458-2159
Mailing Address2805 S Industrial Hwy Ste 100Ann Arbor, MI 48104-6791
Sole ProprietorNo
Enumeration DateJune 10, 2026
NPPES CertifiedJune 10, 2026
NPI 1629902192 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyBehavior TechnicianBehavioral Health & Social Service Providers
Taxonomy Code106S00000X
Definition

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 may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work.

2760 NORTHSIDE DR W, Statesboro, GA 30458

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Behavior Technician
2760 NORTHSIDE DR W
STATESBORO, GA 30458
Behavior Technician
2760 NORTHSIDE DR W
STATESBORO, GA 30458
Behavior Technician
2760 NORTHSIDE DR W
STATESBORO, GA 30458
Behavior Technician
2760 NORTHSIDE DR W
STATESBORO, GA 30458
Behavior Technician
2760 NORTHSIDE DR W
STATESBORO, GA 30458

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenosha Archie-wallace's NPI number?

The NPI number for Kenosha Archie-wallace is 1629902192. It was assigned to this individual provider in the NPPES registry on June 10, 2026.

Where is Kenosha Archie-wallace located?

Kenosha Archie-wallace practices at 2760 Northside Dr W, Statesboro, GA 30458. The listed phone number is (912) 208-2024.

What is Kenosha Archie-wallace's specialty?

The primary specialty registered for this NPI is Behavior Technician with taxonomy code 106S00000X.

When was this NPI record last updated?

The NPPES record for Kenosha Archie-wallace was last updated on June 10, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.