Individual
COLBY WAYNE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
708 MOUNT CROSS RD, DANVILLE, VA 24540-5904
(434) 228-7603
Mailing address
5225 KENTUCK RD LOT 41, RINGGOLD, VA 24586-5068
(434) 228-9572
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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