Individual
MARQUITA LATRICE WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1565 LONGBRANCH RD, GROVER, NC 28073-9599
(704) 915-0282
Mailing address
1840 YELLOWSTONE CT APT B, GASTONIA, NC 28054-1770
(704) 915-0282
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/25/2019
Last updated
10/25/2019
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