Provider Demographics
NPI:1518437250
Name:WETHERALD, DANIELLE SHIVER (BCBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHIVER
Last Name:WETHERALD
Suffix:
Gender:F
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:PO BOX 70301
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-0301
Mailing Address - Country:US
Mailing Address - Phone:229-343-2572
Mailing Address - Fax:833-536-1738
Practice Address - Street 1:2411 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2225
Practice Address - Country:US
Practice Address - Phone:229-461-5926
Practice Address - Fax:833-536-1738
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst