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1154931129
KRISTIN WALLACE
MADISON, MS
NPI
1154931129
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: MS M8300)
Enumeration Date
2020-08-05
Last Update Date
2020-08-05
Business Address
KRISTIN WALLACE
940 EBENEZER BLVD
MADISON, MS 39110-6002
Phone number: 601-790-0583
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Mailing Address
KRISTIN WALLACE
437 PIN OAK DR
MADISON, MS 39110-9365
Phone number:
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