Individual
MIATA QUINTAE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1524 VOLVO PKWY STE B, CHESAPEAKE, VA 23320-1516
(757) 404-5355
Mailing address
957 DUCK POND DR APT 301, VIRGINIA BEACH, VA 23464-3340
(757) 910-9351
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
VA
Other
Enumeration date
10/29/2025
Last updated
10/29/2025
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