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1225579899
MICHAEL WALLACE
REDWOOD CITY, CA
NPI
1225579899
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-03-16
Last Update Date
2017-03-16
Business Address
-- MICHAEL WALLACE
500 ALLERTON ST SECOND FLOOR
REDWOOD CITY, CA 94063-1519
Phone number: 650-599-9955
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Mailing Address
-- MICHAEL WALLACE
500 ALLERTON ST SECOND FLOOR
REDWOOD CITY, CA 94063
Phone number: 650-599-9955
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