Individual
MRS. LETITIA J WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
8401 MAYLAND DR # 5766, RICHMOND, VA 23294-4648
(804) 635-6535
Mailing address
8401 MAYLAND DR # 5766, RICHMOND, VA 23294-4648
(804) 635-6535
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001236086
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024193187
VA
Other
Enumeration date
08/05/2015
Last updated
06/26/2025
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