Provider Demographics
NPI:1396570081
Name:DOLLARD, TAKAYLA KAREEMA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:TAKAYLA
Middle Name:KAREEMA
Last Name:DOLLARD
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 DULUTH HWY APT 4310
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-0004
Mailing Address - Country:US
Mailing Address - Phone:770-549-6865
Mailing Address - Fax:
Practice Address - Street 1:2200 DULUTH HWY APT 4310
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-0004
Practice Address - Country:US
Practice Address - Phone:770-549-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-24-74120103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst