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1114746765
ALICIA S WALLACE
BLOOMINGTON, IL
NPI
1114746765
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2024-10-09
Last Update Date
2024-10-09
Business Address
ALICIA S WALLACE
108 W MARKET ST
BLOOMINGTON, IL 61701-3918
Phone number: 309-827-5351
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Mailing Address
ALICIA S WALLACE
108 W MARKET ST
BLOOMINGTON, IL 61701-3918
Phone number: 309-827-5351
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