Individual
TAVIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LGSW
Contact information
Practice address
2121 7TH ST, PARKERSBURG, WV 26101-3803
(304) 485-1721
Mailing address
2121 7TH ST, PARKERSBURG, WV 26101-3803
(304) 485-1721
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00947323
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386795516
—
WV
Enumeration date
05/17/2016
Last updated
10/17/2025
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