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General NPI Number Information
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NPI Number | 1801141080
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Entity Type | Individual
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Provider Name | ALICE M WALKUP MS, BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 1845 LIBERTY PKWY NW
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City | ATLANTA
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State | GA
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Zip | 30318-9383
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Country | US
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Telephone | 334-744-2648
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 LIBERTY PKWY NW
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City | ATLANTA
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State | GA
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Zip | 30318-9383
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Country | US
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Telephone | 334-744-2648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-11860
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License Number State | CA
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