Individual
TIFFANY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
5881 LUDINGTON DR, VIRGINIA BEACH, VA 23464-1546
(757) 288-1363
Mailing address
5881 LUDINGTON DR, VIRGINIA BEACH, VA 23464-1546
(757) 288-1363
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6728
—
VA
Enumeration date
02/24/2022
Last updated
02/24/2022
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