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1063810877
DEDRA WALLACE
PUEBLO, CO
NPI
1063810877
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: CO LPC.0013214)
Enumeration Date
2014-12-10
Last Update Date
2016-10-19
Business Address
-- DEDRA WALLACE
1302 CHINOOK LN
PUEBLO, CO 81001-1851
Phone number: 719-545-2746
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Mailing Address
-- DEDRA WALLACE
41 MONTEBELLO ROAD SUITE 200
PUEBLO, CO 81004-1128
Phone number: 719-545-2746
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