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1528667060
DUSTIN WADE WALLACE
GLENDALE, AZ
NPI
1528667060
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: LCSW-21756)
Enumeration Date
2020-10-24
Last Update Date
2023-08-29
Business Address
Mr. DUSTIN WADE WALLACE LCSW
4619 W SAGUARO DR
GLENDALE, AZ 85304-4424
Phone number: 602-999-3355
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Mailing Address
Mr. DUSTIN WADE WALLACE LCSW
4619 W SAGUARO DR
GLENDALE, AZ 85304-4424
Phone number: 602-999-3355
Copy
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