Individual
SASHA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 MCHENRY VILLAGE WAY STE 11B, MODESTO, CA 95350-4341
(209) 550-5850
Mailing address
1700 MCHENRY VILLAGE WAY STE 11B, MODESTO, CA 95350-4341
(209) 550-5850
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/24/2021
Last updated
02/06/2023
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