Individual
MS. TYRESHA LYNA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
45528 COOSAN CT, GREAT MILLS, MD 20634-2454
(443) 404-9473
Mailing address
1517 REISTERSTOWN RD, PIKESVILLE, MD 21208-4325
(410) 541-1316
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
374J00000X
Doula
Primary
—
MD
Other
Enumeration date
01/31/2025
Last updated
06/15/2026
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