Individual
EDWINA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 MICHIGAN AVE W, BATTLE CREEK, MI 49017-3602
(269) 966-1460
(269) 966-2844
Mailing address
140 MICHIGAN AVE W, BATTLE CREEK, MI 49017-3602
(269) 966-1460
(269) 966-2844
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401011732
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401011732
LICENSE NUMBER
MI
Enumeration date
10/18/2018
Last updated
10/18/2018
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