Provider Demographics
NPI:1487467338
Name:WALLACE, REBBIE ARPTISHA
Entity type:Individual
Prefix:
First Name:REBBIE
Middle Name:ARPTISHA
Last Name:WALLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ROUND TABLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4292
Mailing Address - Country:US
Mailing Address - Phone:404-550-7671
Mailing Address - Fax:
Practice Address - Street 1:110 WALKER AVE NE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4739
Practice Address - Country:US
Practice Address - Phone:256-534-8659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker