Healthcare Provider Details

I. General information

NPI: 1336893379
Provider Name (Legal Business Name): WETHERALD BEHAVIORAL CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 WESTGATE DR
ALBANY GA
31707-2225
US

IV. Provider business mailing address

PO BOX 70301
ALBANY GA
31708-0301
US

V. Phone/Fax

Practice location:
  • Phone: 229-343-2573
  • Fax: 833-536-1738
Mailing address:
  • Phone: 229-343-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE WETHERALD
Title or Position: OWNER
Credential: BCBA
Phone: 229-343-2572