Individual
MISS ANNA ODESSA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 E 7TH ST, CHARLOTTE, NC 28204-6300
(704) 960-7229
Mailing address
1401 E 7TH ST, CHARLOTTE, NC 28204-6300
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/12/2020
Last updated
07/12/2020
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