Wallace, Tavia

Wallace, Tavia is an individual health care provider with primary practice located at 2121 7Th St , Parkersburg WV 26101-3803. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Wallace, Tavia can be contacted via phone (304) 485-1721.

Contact Information

Primary practice address
2121 7Th St Parkersburg WV 26101-3803
Phone: (304) 485-1721
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X BP00947323 West Virginia

Profile Details

NPI number 1306293659
LBN Legal business name Wallace, Tavia
Credentials MSW, LGSW
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2016
Last updated Oct 17th, 2025 - about last year

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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Identifiers

StateTypeNumberIssuer
All States NPI 1306293659 NPPES
West Virginia MEDICAID 1386795516

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