Individual
AMY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4530 WALNEY RD STE 105, CHANTILLY, VA 20151-2285
(619) 818-1807
Mailing address
2330 DULLES STATION BLVD APT 2229, HERNDON, VA 20171-6196
(972) 400-2932
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/26/2025
Last updated
09/26/2025
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