| NPI | 1497427454 |
|---|---|
| Former Name | AMANDA MARION WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 11750) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 108465) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2022-12-09 |