| NPI | 1740505460 |
|---|---|
| Former Name | NICOLE MARIE WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005950A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001005A) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2020-12-10 |