TARA BANKS WALLACE

FAIRFAX, VA
NPI1457644585
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy103TC2200X Psychologist, Clinical Child & Adolescent
(Licence: VA  0810004361)
Enumeration Date2011-05-23
Last Update Date2011-05-23
Business Address
-- TARA BANKS WALLACE Psy.D.
8626 LEE HWY STE 200
FAIRFAX, VA 22031-2135
Phone number: 571-393-0075
Mailing Address
-- TARA BANKS WALLACE Psy.D.
12043 ELLIOTS OAK PL
BRISTOW, VA 20136-1265
Phone number:
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