DIANE TAMARA WALLACE

UNION, NJ
NPI1912729500
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: NJ  37AC00711600)
Enumeration Date2024-10-25
Last Update Date2024-10-25
Business Address
Mrs. DIANE TAMARA WALLACE LAC
1830 MANOR DR
UNION, NJ 07083-4617
Phone number: 973-978-2858
Mailing Address
Mrs. DIANE TAMARA WALLACE LAC
1830 MANOR DR
UNION, NJ 07083-4617
Phone number: 973-978-2858
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