Rachael Fuller Wallace
Behavior Technician in Newnan, GA. Individual provider (NPI-1).
NPI number1013552017
StatusActive
Last updated in NPPESNov 13, 2019
Details
- NPI
- 1013552017
- Entity type
- Individual (NPI-1)
- Name
- Rachael Fuller Wallace
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 13, 2019
- Last updated
- Nov 13, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
112 Jefferson PkwyNewnan, GA 30263-5885
Phone 877-288-4760
Mailing address
140 N Davis Rd Apt 323Lagrange, GA 30241-1608
Phone 912-508-4449
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