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Individual
JAMAAL AQEEL WALLACE
Active
Individual
JAMAAL AQEEL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
173039
CA
101YM0800X
Mental Health Counselor
Primary
ASW94271
CA
Other
Enumeration date
03/04/2021
Last updated
08/03/2021
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