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1952820292
VICTORIA LYNN WALLACE
PUEBLO, CO
NPI
1952820292
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-09-19
Last Update Date
2017-09-19
Business Address
VICTORIA LYNN WALLACE
79 BONNYMEDE RD APT 104
PUEBLO, CO 81001-8100
Phone number: 720-985-4453
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Mailing Address
VICTORIA LYNN WALLACE
79 BONNYMEDE RD APT 104
PUEBLO, CO 81001-1313
Phone number: 720-985-4453
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