Provider Demographics
NPI:1053992529
Name:CARLL, WALTER (BCBA)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:CARLL
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1997
Mailing Address - Country:US
Mailing Address - Phone:803-351-3004
Mailing Address - Fax:
Practice Address - Street 1:410 S HAMPTON CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1997
Practice Address - Country:US
Practice Address - Phone:803-563-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst