Individual
KRISTEN NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
834 TYVOLA RD STE 126, CHARLOTTE, NC 28217-3598
(980) 785-1113
(980) 785-1114
Mailing address
2810 COLISEUM CENTRE DR STE 520, CHARLOTTE, NC 28217-3252
(980) 785-1113
(980) 785-1114
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-51057
NC
Other
Enumeration date
07/03/2021
Last updated
07/24/2024
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