Tara Wallace, PSY.D

NPI 1457644585 · on the registry since 2011 · sole proprietor

Practice

Address: 8626 Lee Hwy Ste 200
Fairfax, VA 22031
Phone: (571) 393-0075
Organisation at this address: Family And Cosmetic Dentistry
Gil Center For Healing And Play
Gil Institute For Trauma Recovery And Education, Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 19

Registry record

Primary taxonomy: 103TC2200X
103TC2200X
Licence states on file: VA
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2011-05-23

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Virginia