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1184275802
DERRICK PAUL WALLACE
LEXINGTON, KY
NPI
1184275802
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
Enumeration Date
2019-09-24
Last Update Date
2019-09-24
Business Address
Mr. DERRICK PAUL WALLACE
2375 PROFESSIONAL HEIGHTS DR STE 240
LEXINGTON, KY 40503-3040
Phone number: 855-591-0092
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Mailing Address
Mr. DERRICK PAUL WALLACE
2275 ROBINSON RENAKER RD
BERRY, KY 41003-8521
Phone number: 859-699-0090
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