Individual
KURTASHA D WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
51 SHUMATE DR, COLLINSVILLE, VA 24078-1652
(276) 806-9615
Mailing address
3602 NELSON CREEK LN, GREENSBORO, NC 27406-9816
(276) 806-9615
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/10/2023
Last updated
01/24/2023
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