Provider Demographics
NPI:1336893379
Name:WETHERALD BEHAVIORAL CONSULTING, INC
Entity Type:Organization
Organization Name:WETHERALD BEHAVIORAL CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHERALD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:229-343-2572
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:
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:229-343-2573
Practice Address - Fax:833-536-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003236365BMedicaid