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1033589247
JERRON WALLACE
ALBUQUERQUE, NM
NPI
1033589247
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NM X-09336)
Enumeration Date
2015-09-30
Last Update Date
2017-01-19
Business Address
-- JERRON WALLACE LMSW
912 1ST ST NW
ALBUQUERQUE, NM 87102-2355
Phone number: 505-224-9777
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Mailing Address
-- JERRON WALLACE LMSW
912 1ST ST NW
ALBUQUERQUE, NM 87102-2355
Phone number: 505-224-9777
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