Individual
KIRSTEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1505 BLANDING ST, COLUMBIA, SC 29201-2906
(803) 929-0011
Mailing address
130 FORGE FARM CT, IRMO, SC 29063-2225
(803) 800-5233
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
03/03/2021
Last updated
03/03/2021
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