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1912364787
BONITA LUCILLE WALLACE
ATLANTA, GA
NPI
1912364787
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: GA 1823)
Enumeration Date
2016-01-25
Last Update Date
2016-01-25
Business Address
Mrs. BONITA LUCILLE WALLACE LPC
550 PHARR RD NE SUITE 605
ATLANTA, GA 30305-3428
Phone number: 404-664-6398
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Mailing Address
Mrs. BONITA LUCILLE WALLACE LPC
550 PHARR RD NE SUITE 605
ATLANTA, GA 30305-3428
Phone number: 404-664-6398
Copy
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