Individual provider · Type 1 NPI

Khaira-Nisaa Hicks Wallace

Behavior Technician · Charlotte, NC

NPI number 1417818113 Active

Practice location

1300 Baxter St Ste 450
Charlotte, NC 28204-3026

Call (704) 366-1075 Map

Mailing address

404 Minglewood Dr Unit 7108
Charlotte, NC 28262-0064

Specialties and licenses

TaxonomyCodeLicense
Behavior Technician Primary 106S00000XRBT-24-398908 (NC)

Behavior Technician: The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That…

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About NPI 1417818113

Khaira-Nisaa Hicks Wallace's National Provider Identifier is 1417818113, issued on Nov 21, 2025. The primary taxonomy on file is Behavior Technician (106S00000X), and the practice location is in Charlotte, NC. The record was last updated on Nov 21, 2025.