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1861032864
KEYONNA WALLACE
KEW GARDENS, NY
NPI
1861032864
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NY 31387)
Enumeration Date
2020-01-08
Last Update Date
2020-10-19
Business Address
KEYONNA WALLACE
8002 KEW GARDENS RD STE 704
KEW GARDENS, NY 11415-3607
Phone number: 718-520-1513
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Mailing Address
KEYONNA WALLACE
79 GLENRIDGE RD
GLENVILLE, NY 12302-4523
Phone number:
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