Provider Demographics
NPI:1932902400
Name:RISE ABA THERAPY
Entity type:Organization
Organization Name:RISE ABA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:ME D, BCBA, LBA
Authorized Official - Phone:843-592-8582
Mailing Address - Street 1:157 RIVER WINDING RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-9394
Mailing Address - Country:US
Mailing Address - Phone:843-592-8582
Mailing Address - Fax:
Practice Address - Street 1:845 N 20TH ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1024
Practice Address - Country:US
Practice Address - Phone:843-592-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center