WALLACE GOODMAN

HAYTI, MO
NPI1427488055
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MO  2011024580)
Enumeration Date2013-11-18
Last Update Date2013-11-18
Business Address
-- WALLACE GOODMAN
501 HIGHWAY J N
HAYTI, MO 63851
Phone number: 573-359-2600
Mailing Address
-- WALLACE GOODMAN
2009 SOUTHWIND CV
DYERSBURG, TN 38024-8875
Phone number:
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