| NPI | 1992713150 |
|---|---|
| Former Name | CARA LISA WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX TXLPC#14782) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 14782) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2011-09-13 |