Individual
ERIKA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8515 LYN AVE, SAVANNAH, GA 31406-6019
(912) 428-5275
Mailing address
8515 LYN AVE, SAVANNAH, GA 31406-6019
(912) 428-5275
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-83196
GA
Other
Enumeration date
04/26/2019
Last updated
04/26/2019
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