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NPI Code Detail

MEDICARE: RACHEL LORRAINE WALLACE DUCLAY

MEDICARE: RACHEL LORRAINE WALLACE DUCLAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1104674704
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL LORRAINE WALLACE DUCLAY
Provider Business Mailing Address
First Line : 2827 OLDE WHITEHALL RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-3132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7809 SARDIS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28270-2757
Country : US
Telephone Number : 910-918-1551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2024
Last Update Date : 01/15/2026

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Directions to “ RACHEL LORRAINE WALLACE DUCLAY ” Practice Location

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