NPI Profile for DEBORAH F WALLACE in CARLINVILLE, IL.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X |
| NPI Number | 1235999293 |
|
| Status | Active | |
| Credentials | LCPC LICENSED CLINIC | |
| Entity | Individual | |
| Enumeration date | 03/19/2024 | |
| Last updated | 03/19/2024 - About 2 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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DEBORAH F WALLACE
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