| NPI | 1538557012 |
|---|---|
| Other Name | JEFF WALLACE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA SC60493319) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC60493319) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60490069) | |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2019-01-28 |