Individual
ERICA LYNN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5286 SUMMERTON HWY, MANNING, SC 29102-8240
(803) 225-6332
Mailing address
5286 SUMMERTON HWY, MANNING, SC 29102-8240
(803) 225-6332
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
SC
Other
Enumeration date
07/01/2022
Last updated
07/01/2022
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