Individual
JACAEL OLIA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7409 COLCHESTER DR, CLINTON, MD 20735-1318
(240) 351-5177
Mailing address
7409 COLCHESTER DR, CLINTON, MD 20735-1318
(240) 351-5177
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
MD
Other
Enumeration date
01/07/2022
Last updated
01/07/2022
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