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Individual
MARK WOLLAM
Active
Individual
MARK WOLLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149019737
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149019737
LCSW LICENSE
IL
Enumeration date
09/08/2016
Last updated
11/01/2017
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