Individual
CAROLYN ANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPCC, CADC, MS
Contact information
Practice address
25 MIDDLE ST, PORTLAND, ME 04101-4869
(207) 653-3999
Mailing address
25 MIDDLE ST, PORTLAND, ME 04101-4869
(207) 653-3999
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC4223
ME
101YM0800X
Mental Health Counselor
Primary
XL3204
ME
Other
Enumeration date
03/14/2007
Last updated
01/27/2009
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