CHARLES JEROME WALLACE

NEW YORK, NY
NPI1780125203
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2017-03-16
Last Update Date2017-03-16
Business Address
-- CHARLES JEROME WALLACE Casac-T
55 W 125TH ST FL 11
NEW YORK, NY 10027-4516
Phone number: 212-864-4128
Mailing 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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