Josephine Wallace, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-23-307724 Issued in VA

Practice address

804 Moorefield Park Dr Ste 101
North Chesterfield, VA 23236-3670

Phone

(804) 985-1050

NPI assigned

Nov 6, 2024

Sex

Unspecified or another gender identity

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autism Center of Excellence LLC

  • Community/Behavioral Health Agency
  • Columbia, MD
  • NPI 1730822933

  Behavior Technician

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1306669544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4585 MARSHALL RUN CIR APT 101",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595888",
            "telephone_number": "678-633-9120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 MOOREFIELD PARK DR STE 101",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232363670",
            "telephone_number": "804-985-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOSEPHINE",
        "credential": "RBT",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2024-11-06",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "VA",
            "license": "RBT-23-307724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiney Chardonay Walker, LCSW
• Gordon R. Walker Jr., PH.D.
• Matthew Walker
• Roneece Walker
• Stephanie Walker, RDN
• Sharon Marie Walton, RN
• Jostiena Wanis
• Ward Behavioral Consulting Group LLC
• Kimani Ward, BCBA
• Marin Elizabeth Ward

• Behavior Technician in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• Behavior Technician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.