Individual
LAURA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
925 ROXBURGH AVE, ROCK HILL, SC 29732-5505
(803) 487-8508
Mailing address
925 ROXBURGH AVE, ROCK HILL, SC 29732-5505
(803) 487-8508
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BACB476683
SC
Other
Enumeration date
05/14/2020
Last updated
10/05/2020
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