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1598124992
GENNIFER WALLACE
CHARLESTOWN, IN
NPI
1598124992
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2016-02-15
Last Update Date
2016-02-15
Business Address
Mrs. GENNIFER WALLACE MA
7509 CHARLESTOWN PIKE
CHARLESTOWN, IN 47111-9623
Phone number: 812-256-4686
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Mailing Address
Mrs. GENNIFER WALLACE MA
7509 CHARLESTOWN PIKE
CHARLESTOWN, IN 47111-9623
Phone number: 812-256-4686
Copy
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