Healthcare Provider Details

I. General information

NPI: 1346948866
Provider Name (Legal Business Name): WALTER DANIEL OLIVER BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BURLEYSON RD
DALTON GA
30720-3019
US

IV. Provider business mailing address

1201 BURLEYSON RD
DALTON GA
30720-3019
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-8900
  • Fax: 706-226-8905
Mailing address:
  • Phone: 706-226-8900
  • Fax: 706-226-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-98514
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA003067
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: