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1205677150
KIMBERLEY R WALLACE
LONGVIEW, TX
NPI
1205677150
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: TX 17017)
Enumeration Date
2024-06-04
Last Update Date
2024-06-05
Business Address
KIMBERLEY R WALLACE LCDC
107 WOODBINE PL
LONGVIEW, TX 75601-2912
Phone number: 903-758-2471
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Mailing Address
KIMBERLEY R WALLACE LCDC
107 WOODBINE PL
LONGVIEW, TX 75601-2912
Phone number: 903-758-2471
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