Provider Demographics
NPI:1801141080
Name:WALKUP, ALICE M (MS, BCBA)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:M
Last Name:WALKUP
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 1:1845 LIBERTY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-9383
Mailing Address - Country:US
Mailing Address - Phone:334-744-2648
Mailing Address - Fax:
Practice Address - Street 1:1845 LIBERTY PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-9383
Practice Address - Country:US
Practice Address - Phone:334-744-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-11860103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst