Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Khaira-Nisaa Hicks Wallace

Individual provider Behavior Technician · NPI 1417818113

Khaira-Nisaa Hicks Wallace is a Behavior Technician in Charlotte, North Carolina. Practices as a sole proprietor. Licensed in North Carolina.

Licensed in
NC
In the registry since
2025

Practice location Address checks out

1300 Baxter St Ste 450
Charlotte, NC 28204-3026
Phone: (704) 366-1075
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X · Licence RBT-24-398908 (NC)

Record details

NPI number1417818113
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 21, 2025
Last updated in NPPESNovember 21, 2025
Certification dateNovember 21, 2025

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