Individual
JENNIFER WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC, RPT
Contact information
Practice address
110 SAMARITAN DR, SUITE 110, CUMMING, GA 30040-2535
(888) 850-4891
Mailing address
110 SAMARITAN DR, SUITE 110, CUMMING, GA 30040-2535
(888) 850-4891
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007671
GA
Other
Enumeration date
10/28/2015
Last updated
10/28/2015
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