Antoine Wallace
Behavior Technician in Columbia, MD. Individual provider (NPI-1).
NPI number1407367162
StatusActive
Last updated in NPPESOct 20, 2017
Details
- NPI
- 1407367162
- Entity type
- Individual (NPI-1)
- Name
- Antoine Wallace
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 20, 2017
- Last updated
- Oct 20, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
6355 Woodside CtColumbia, MD 21046-1071
Phone 410-381-7171
Mailing address
6355 Woodside CtColumbia, MD 21046-1071
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