Individual
ALICIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
8005B TORO CREEK RD, ATASCADERO, CA 93422-1028
(805) 704-7586
Mailing address
PO BOX 2157, ATASCADERO, CA 93423-2157
(805) 704-7586
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-16269
CA
Other
Enumeration date
08/28/2014
Last updated
02/05/2020
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