EVERETT WALLACE

INDIO, CA
NPI1528655107
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA  Ci30830920)
Enumeration Date2020-12-29
Last Update Date2020-12-29
Business Address
EVERETT WALLACE
44374 PALM ST
INDIO, CA 92201-3117
Phone number: 760-342-6616
Mailing Address
EVERETT WALLACE
1488 E RAMON RD APT 129
PALM SPRINGS, CA 92264-0828
Phone number: 901-581-0817
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