Individual
JOSEPHINE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
RBT
Contact information
Practice address
804 MOOREFIELD PARK DR STE 101, NORTH CHESTERFIELD, VA 23236-3670
(804) 985-1050
Mailing address
4585 MARSHALL RUN CIR APT 101, GLEN ALLEN, VA 23059-5888
(678) 633-9120
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-307724
VA
Other
Enumeration date
11/06/2024
Last updated
11/06/2024
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