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1649522400
AYESHA WALLACE
LOS ANGELES, CA
NPI
1649522400
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: CA 79411)
Enumeration Date
2012-10-03
Last Update Date
2017-09-27
Business Address
-- AYESHA WALLACE
710 E 111TH PL
LOS ANGELES, CA 90059-1518
Phone number: 323-233-0425
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Mailing Address
-- AYESHA WALLACE
4211 AVALON BLVD
LOS ANGELES, CA 90011-5622
Phone number: 323-233-0425
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