Wallace, Tara Banks
Wallace, Tara Banks is an sole proprietor health care provider with primary practice located at 8626 Lee Hwy Ste 200 , Fairfax VA 22031-2135. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as her primary health care specialty. Wallace, Tara Banks can be contacted via phone (571) 393-0075.Contact Information
Primary practice address
8626 Lee Hwy Ste 200
Fairfax VA 22031-2135
Phone: (571) 393-0075
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | 0810004361 | Virginia |
Profile Details
| NPI number | 1457644585 |
|---|---|
| LBN Legal business name | Wallace, Tara Banks |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 23rd, 2011 |
| Last updated | May 23rd, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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