Individual
CHASITY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
633 BRENNAN LN SW, ATLANTA, GA 30310-2202
(404) 441-9768
Mailing address
633 BRENNAN LN SW, ATLANTA, GA 30310-2202
(404) 441-9768
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/19/2024
Last updated
03/19/2024
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