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Individual

CAMILLE WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCBA, LBA

Contact information

Practice address
2104 MIRAMONTE AVE APT 9, SAN LEANDRO, CA 94578-1549
(510) 298-8463
Mailing address
2302 HILLSIDE CT, SOUTHLAKE, TX 76092-5709
(682) 252-8439

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-46247
CA

Other

Enumeration date
05/17/2018
Last updated
04/05/2025
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