| NPI | 1578285979 |
|---|---|
| Former Name | VICTORIA MARIE WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012809) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 16990) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2022-09-13 |