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Individual
COURTNEY CREAL WALLACE
Active
Individual
COURTNEY CREAL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1771
KY
1041C0700X
Clinical Social Worker
Primary
3882
KY
Other
Enumeration date
08/06/2013
Last updated
05/28/2014
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