Individual
LISA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1155 CULLY RD, CORDOVA, TN 38018-8502
(901) 624-2454
Mailing address
1155 CULLY RD, CORDOVA, TN 38018-8502
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
09/07/2017
Last updated
09/07/2017
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