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1295433167
ANDREW NATHAN WALLACE
CANTON, GA
NPI
1295433167
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: GA CSW008417)
Enumeration Date
2023-02-21
Last Update Date
2023-04-25
Business Address
ANDREW NATHAN WALLACE LCSW
191 LAMAR HALEY PKWY
CANTON, GA 30114-8019
Phone number: 770-704-1600
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Mailing Address
ANDREW NATHAN WALLACE LCSW
1193 WADE GREEN CIR NW
ACWORTH, GA 30102-3491
Phone number: 770-866-6851
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