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1174025985
ANTHONY WALLACE
CORAL GABLES, FL
NPI
1174025985
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
Additional Taxonomies
101YM0800X Counselor, Mental Health
Enumeration Date
2018-03-07
Last Update Date
2018-03-07
Business Address
Mr. ANTHONY WALLACE Master
2222 PONCE DE LEON BLVD FL 3
CORAL GABLES, FL 33134-5039
Phone number: 866-305-7365
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Mailing Address
Mr. ANTHONY WALLACE Master
2222 PONCE DE LEON BLVD FL 3
CORAL GABLES, FL 33134-5039
Phone number: 866-305-7365
Copy
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