Provider Demographics
NPI:1467178616
Name:DALTON, BREANNA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 POWERS AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36205-4419
Mailing Address - Country:US
Mailing Address - Phone:256-847-5942
Mailing Address - Fax:
Practice Address - Street 1:664 POWERS AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36205-4419
Practice Address - Country:US
Practice Address - Phone:256-847-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2023-002103K00000X
AL0-22-13879106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst