| NPI | 1043612872 |
|---|---|
| Former Name | AMBER WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 20375) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 20375) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2025-10-14 |