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1780125203
CHARLES JEROME WALLACE
NEW YORK, NY
NPI
1780125203
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-03-16
Last Update Date
2017-03-16
Business Address
-- CHARLES JEROME WALLACE Casac-T
55 W 125TH ST FL 11
NEW YORK, NY 10027-4516
Phone number: 212-864-4128
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Mailing Address
-- CHARLES JEROME WALLACE Casac-T
55 W 125TH ST FL 11
NEW YORK, NY 10027-4516
Phone number: 212-864-4128
Copy
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