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NPI Profile for WILLIAM WALLACE in CALIFORNIA, MO.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Addiction (Substance Use Disorder) |
101YA0400X |
| NPI Number | 1255765194 |
|
| Status | Active | |
| Credentials | CRAADC, PLPC | |
| Entity | Individual | |
| Enumeration date | 08/28/2013 | |
| Last updated | 04/16/2015 - About 11 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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WILLIAM WALLACE
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WILLIAM WALLACE, CRAADC, PLPC