Individual
TAKISHA WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18 CUMMING STREET, ALPHARETTA, GA 30009
(470) 500-0105
(646) 859-4440
Mailing address
1055 E COLORADO BLVD STE 560, PASADENA, CA 91106-2380
(818) 241-6780
(818) 241-6853
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-52936
GA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/11/2019
Last updated
02/15/2022
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